Health Policy & Advocacy
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, MD
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, MD
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, MD
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, MD
Dr. Chao’s policy and advocacy efforts focus on improving access to evidence-based complementary and integrative medicine for underserved populations. Her current work includes broadening non-pharmacologic options for pain management in primary care and evaluating the implementation of acupuncture in safety net settings to improve quality of life among patients with chronic conditions. She has published on racial/ethnic differences in reasons for using complementary health approaches, factors that affect disclosure of complementary medicine use to healthcare providers, and socioeconomic access to integrative health through group-based models. Dr. Chao is a member of the steering committee for the Integrative Pain Management Program of the San Francisco Health Network. She co-chairs a Working group on Traditional and Complementary Medicine Research in Asian American Communities and serves on the Board of Directors Integrative Medicine for the Underserved, a national multi-disciplinary organization committed to affordable, accessible integrative health care for all.
Alice Chen, MD
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, MD
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, MD
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, MD
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)
Leigh Kimberg, MD
Dr. Leigh Kimberg’s policy and advocacy work focuses on two areas, violence prevention and the diversity of the healthcare workforce. She has worked on policy and advocacy initiatives to prevent and mitigate the adverse effects of violence and trauma and promote models of trauma-informed and resiliency-promoting healthcare. Dr. Kimberg has served on national advisory boards convened by Futures without Violence (previously the Family Violence Prevention Fund) to develop national guidelines on addressing intimate partner violence in healthcare practice; she has also advocated for these guidelines to be adopted and implemented locally. Currently, she is federally funded to study the implementation of the Affordable Care Act’s mandate to provide all girls and women with IPV counseling and services. Dr. Kimberg serves as the San Francisco Department of Public Health representative to the Board of Supervisors mandated San Francisco Family Violence Council (SF FVC). Through the SF FVC, she participates in formulating local violence prevention and intervention policies in collaboration with other governmental and community-based organization partners. Dr. Kimberg also serves on a national taskforce convened by the Substance Abuse and Mental Health Services Administration (SAMHSA) to develop and disseminate models of trauma-informed care. As the Program Director for Program in Medical Education for the Urban Underserved (PRIME-US) at UCSF and the UCB-UCSF Joint Medical Program, she participates in policy and advocacy efforts to increase the diversity of the healthcare workforce. She is also privileged and honored to have the opportunity to actively support the policy and advocacy efforts of the PRIME-US students, who are national leaders in many areas including access to care, immigrant’s rights, DACA, and more.
Margot Kushel, MD
Dr. Kushel’s policy work focuses on addressing housing as a key social determinant of health. Her work aims to create the evidence base for policy responses to prevent and end homelessness and mitigate the effects of housing instability on health. Dr. Kushel works with diverse stakeholders at the local, regional, and national level to inform and implement programmatic and policy changes based on her research, which focuses on the causes and consequences of homelessness in older adults and the effects of various housing interventions on health care utilization and health outcomes. She has provided testimony at California state legislative committees, presented her findings at local, regional, and national conferences, and is a frequent speaker to medical and lay audiences on highly vulnerable populations both in person and through traditional and new media. She is a leadership board member of Everyone Home, which coordinates homeless policy in Alameda County. She serves as an evaluator of multiple initiatives seeking to address homelessness, including Santa Clara’s Pay for Success funded supportive housing initiative, Tipping Point’s Chronic Homelessness Initiative and Whole Person Care in San Francisco.
Courtney Lyles, PhD
Dr. Lyles’s policy work currently focuses on health information technology implementation and digital inclusion, specifically patient engagement and digital/health literacy among vulnerable populations. Dr. Lyles advocates for the design and dissemination of better health information technology tools for vulnerable patients, through better skills training and support, increased usability standards, and metrics that demonstrate true patient engagement.
Neda Ratanawongsa, MD
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, MD
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, MD
Dr. Schillinger has focused his policy efforts for vulnerable populations in two domains: diabetes and health communication. Dr. Schillinger is a scientific and public health expert on the root causes of the global diabetes epidemic and has been instrumental in engaging the scientific community in the critical policy discourse related to the dangers of unmitigated added sugar consumption. He served as the scientific expert for the City and County of San Francisco in the successful defense of a lawsuit filed in Federal Court by the American Beverage Association for an injunction against a city ordinance to mandate health warning labels on billboards advertising sugary drinks. Dr. Schillinger has recently authored a number of widely-read original investigations as well as influential public health policy pieces in the Annals of Internal Medicine and JAMA that describe how the sugary beverage industry has been manipulating disparate elements of the scientific process to undermine scientific claims of their products’ health consequences and to create controversy regarding the scientific basis for placing dietary limits on added sugars. To directly engage the affected communities in the emerging crisis of Type 2 diabetes in America’s children, Dr. Schillinger co-created a minority youth-led public health literacy campaign to prevent diabetes that employs social media and spoken word, The Bigger Picture (http://www.thebiggerpicture.org/). The Bigger Picture campaign has had >1.5 million views to date, has been adopted by 3 California counties for their initiatives to reduce sugar-sweetened beverage consumption, and was influential in the passage of sugary drink taxation policies in 4 Bay Area municipalities through its engagement of minority voters. In 2016, Dr. Schillinger received the prestigious James Irvine Leadership Award of California for his work advancing the public health literacy of Californians with respect to the diabetes epidemic. 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.
Hilary Seligman, MD
Dr. Seligman’s policy and advocacy expertise focus on federal nutrition programs (predominantly the Supplemental Nutrition Assistance Program), community food programs (food vouchers, food banks, and food pantries), food affordability and access, and income-related drivers of food choice. She serves as Senior Medical Advisor for Feeding America, the nation’s largest domestic anti-hunger organization. She directs the CDC’s Nutrition and Obesity Policy Research and Evaluation Network (www.nopren.org). She also founded San Francisco’s fruit and vegetable voucher program, EatSF (eatsfvoucher.org), which has since expanded to other cities as Vouchers for Veggies.
Maya Vijayaraghavan, MD
Dr. Vijayaraghavan’s policy work is focused on tobacco control policy, with an emphasis on vulnerable populations. She analyzes national cross-sectional and longitudinal data to examine the differential impact of tobacco control policies on low-income populations in the US. Dr. Vijayaraghavan is interested in the implementation of smoke-free policies in low-income housing, including public housing and supportive housing for formerly homeless adults. She is currently the PI of a grant funded by the Tobacco-Related Disease Research Project on pilot testing a smoke-free home intervention among formerly homeless residents in supportive housing, and the PI of a pilot grant evaluating the implementation of smoke-free policies in San Francisco Public Housing Authority Housing. Dr. Vijayaraghavan’s broader tobacco control policy work also encompasses system-level approaches to increase access to cessation services for low-income populations in the US.