San Francisco is not exempt from the hypertension crisis, nor from the health disparities reflected in the African-American community.

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1 September 2017 San Francisco Health Network Heart Health Patient Communications and Community Events Project Brief and Request for Proposals I. Background Heart disease is the leading cause of death in the United States. Heart disease is a broad term that includes heart attacks, congestive heart failure, coronary artery disease, irregular heartbeats and other disorders. Hypertension, or high blood pressure, increases the risk of heart disease, including heart attack, stroke and congestive heart failure. About one in three American adults have high blood pressure. The prevalence of high blood pressure in African-Americans in the United States is among the highest in the world, according to the American Heart Association. More than 40 percent of non-hispanic African- American men and women have high blood pressure. For African-Americans, high blood pressure also develops earlier in life and is usually more severe. San Francisco is not exempt from the hypertension crisis, nor from the health disparities reflected in the African-American community. Approximately 21 percent of the adults in San Francisco have been diagnosed with hypertension, according to the California Health Interview Survey [CHIS]. Hypertension disproportionately impacts communities of color. Among African American and Latinos in San Francisco the prevalence is higher than 30 percent. The disparities become greater when poverty is factored in. Risk factors for hypertension are both genetic and behavioral. They include: Family history Likelihood increases if parents or other close relatives have high blood pressure. Age The older you are, the more likely you are to get high blood pressure. Gender Until age 45, men are more likely to get high blood pressure than women. Race African-Americans develop high blood pressure more often than other racial groups. Lack of physical activity Not enough exercise increases the risk of high blood pressure. Unhealthy diet, especially one high in sodium Too much salt, calories, saturated fat and sugar increase the risk of high blood pressure Overweight, obesity Being overweight increases the risk of cardiovascular disease, hypertension, heart disease, stroke and diabetes. People with diabetes are more likely to have high blood pressure, heart disease and stroke. Alcohol and tobacco Drinking too much and using tobacco increases the risk of hypertension, heart failure, stroke, irregular heartbeat, as well as accidents, suicides, cancer and obesity.

2 Left untreated hypertension results in diminishing lifespan and quality of life. Today, only about half (54 percent) of the people with high blood pressure have their condition under control. The good news is that hypertension is largely preventable and manageable with lifestyle and habit changes. When managed properly, behavioral improvements decrease the risk of hypertension, heart disease and stroke. About the SF Health Network San Francisco Department of Public Health s (DPH) health care delivery system, the San Francisco Health Network, is a community of top-rated clinics, hospitals and programs that connect San Franciscans to quality health care. The SF Health Network serves primarily Medi-Cal patients, as well as Healthy San Francisco members, people with Medicare, and people who are uninsured. Several of our primary care clinics are located in communities that are disproportionately affected by hypertension. Of the 63,000 patients served in our primary care clinics in the most recent fiscal year ( ), 17 percent were African American, compared with the city s overall African American population of 6 percent. The demographics of the San Francisco Health Network s primary care patients, compared with San Francisco as a whole are: African American Latino Asian White SF Health Network 17% 35% 25% 17% San Francisco % 23% 23% 52% Given the populations we serve, it is incumbent on us to help our patients get control of their hypertension, to lower the disease burden in their communities and to improve the overall health of the city. II. Efforts-to-Date SF DPH has chosen hypertension as one of its focus areas for improving the health of our population. To raise awareness about hypertension and better engage patients in home blood pressure monitoring, healthy lifestyle change and medication adherence, we have had success with at least two approaches to date. Team-based care Our primary care clinics have put many processes in place to improve patient care, including the use of health care teams to provide wrap around support for heart health patients. Tools have been developed to help teams 1) follow evidence-based clinical guidelines and 2) support patients to manage their hypertension through medicine adherence, home blood pressure monitoring and lifestyle changes. This includes the rollout of Registered Nurse Chronic Care Visits, designed to allow for more time spent with the patient, better assessment of medication adherence, and development of alternative care plans focused on home blood pressure monitoring and lifestyle changes, all of which encourage active patient engagement with their health. Additionally, clinical staff have developed a wide variety of hypertension management tools, including a medication algorithm, patient referral algorithm, and home blood pressure monitoring toolkit. Pharmacists are also successfully co-managing patients using these tools. Team-based care has shown success at the clinics where it is being implemented. There is a correlation between improved heart health outcomes and clinics providing team-based care.

3 Community health events Second, a community health event targeting heart health patients was held at one of our large clinics in the African American community, with great results. The day itself was a popular and well-attended event, the direct outreach to heart health patients was effective, and for a period of time afterward, their health measurements improved. Other interventions that we have tried include: Hypertension Fairs i.e. Patient Appreciation Days invitations sent to African American patients with uncontrolled blood pressure; and distribution of free physical activity prescriptions provided to patients in the clinic with hypertension. Through these efforts we have started to move the needle, improving blood pressure control among hypertension patients from 65% in January 2015 to 70% in June Yet we also face challenges with both approaches. For team-based care, we have not communicated the merits sufficiently to patients, who still express the opinion that seeing the doctor is the most desirable form of health care. We are seeking a way to support clinic staff and patients to better explain and socialize the concept of team-based care, the role of nurse, pharmacists and others on the health care team, and its rewards. For the health events, the work involved, including patient outreach, logistics, event planning, enlisting community partners, promotion and ongoing communications exceeds the capacity of our clinic staff and our communications department. We are also still challenged by a lack of ongoing patient engagement. Managing hypertension is a long-term effort requiring ongoing participation by the impacted patients throughout their daily lives, not just at health care appointments. Across the SFHN primary care clinics, Black and African American (B/AA) hypertensive patients have lower rates of blood pressure (BP) control compared to other populations. Approximately 62% percent of Black/African American hypertension patients have controlled blood pressure, compared to 70% of hypertension patients with controlled blood pressure overall. III. Request for Proposals We are accepting proposals for strategic partners to design, create, and manage a program to support SFHN s wider efforts to improve cardiovascular health and hypertension. The work will be done in collaboration with Primary Care and Communications leadership and sitespecific leaders at selected primary care clinics, as well as patient advisors and frontline clinic staff. We do not expect that any one agency or firm will be able to fulfill the complex requirements of this initiative. We intend to select a lead agency and pair up teams or agencies who together have the required capabilities. In your response please include information on your strengths and which Focus Areas you would be best suited for, including the neighborhood locations with which you are most familiar. Please indicate if you would like to be considered for the lead agency role. If you intend to use partnerships to fulfill this work please describe them. If you do envision that you can manage the entire engagement, then state that too. If you are suited to only some parts, please apply anyway. IV. Program Overview The SF Health Network wants to support heart health in San Francisco through programs that empower patients and better connect our health clinics and our communities.

4 We envision a two-pronged approach for the heart health campaign. 1. Support primary care clinics Strengthen clinics communications with heart health patients, typically men and women ages 55 to 85. Collaborate with SF Health Network clinics to find ways that patient communications can increase self-management in our patient population. Design and manage community health events to raise awareness in local communities and to improve patient engagement in self-management. Enhance existing health care programs through improved patient education. Support clinics to more effectively message the value of the non-physician members of the health care team to patients. Create materials aligned with SFHN branding to support patients from high-risk communities to better access and navigate primacy care and wellness services. 2. Support patients Engage high-risk communities in San Francisco with education and wellness programs aimed at improving their heart health. Collaborate with SFHN branding campaign to develop materials to support patients from highrisk communities to better access and navigate SFHN primary care and wellness services. Increase patient awareness and adoption of team-based care approach, which has been effective in helping reduce high blood pressure, but is not well understood by patients, creating a barrier to teambased care. Develop a communications plan that uses the heart health events as a focal point, developing patient communications leading up to and following the events. The partners will focus on: + What would be the most high-impact communications and experiences? + How can we strengthen the clinics ability to communicate with heart health patients? + How can we get the right people to participate? + What are the desired actions and outcomes? How can we measure the impact? + How can we build upon existing initiatives in the city? The partners will create and manage events and communications that support heart health improvements at our community health clinics, focusing on those which serve many African American and Latino patients who are at higher risk of heart disease. The programs will focus on patients who are undiagnosed as well as those who are diagnosed but have uncontrolled blood pressure. Programs will focus on education, engagement, and self-management: - Enlisting uncontrolled hypertensive patients in self-management practices. Teaching them how to work with us to improve their health: Education around team-based services including nurse and pharmacist chronic care visits, behavioral health consultations for stress reduction, and nutrition programs including CalFresh or the Food Pharmacy. - Incorporate into the care model interventions that use food, exercise and movement and medication adherence - Expand access to testing people who may be at risk, don t know they have hypertension, or are pre-hypertensive The programs will be oriented around four of our primary care locations.

5 Southeast Health Center, 2401 Keith Street, Bayview Maxine Hall Health Center, 1301 Pierce Street, Western Addition Potrero Hill Health Center, 1050 Wisconsin Street, Potrero Hill Hospital-based primary care at Zuckerberg San Francisco General Hospital, in the Mission o Family Health Center, 995 Potrero Ave, Buildings 80 and 90 o Richard Fine People s Clinic, 1001 Potrero Ave, Building 5, first floor, 1M As part of the programs we envision that each location would host two health outreach and education events over a two-year period, as well as follow-up activities with patients. V. Scope: Focus Areas, Activities and Deliverables Focus areas Goals and metrics Program development and management Collaboration with clinics and other stakeholders Managing community events Activities and Deliverables Establish programs goals and measurement in two categories: Patient outcomes. Work with clinics to track, build on or augment existing measurements of heart health patients. namely blood pressure control among all active patients and reducing disparities in blood pressure control Campaign outcomes. Establish a method for measuring the success of the heart health campaign, in terms of participation and awareness. Design the programs to meet the objectives above. Manage communications with multiple stakeholders and executive groups Report regularly on progress and issues that need to be managed Lead agency: coordinate additional contract partners, communicate progress to SFHN, work to solve problems, accomplish deliverables and manage within budget Work with clinic representatives to align events with ongoing chronic illness prevention and control efforts Align with ongoing heart health prevention and control efforts in the San Francisco Health Network and Population Health Division of the Health Department (i.e., team-based care at primary care clinics, smoking cessation efforts, food pantries, blood pressure control) Work with clinics to create follow-up processes for high-risk patients Plan and manage all event logistics, before, during and after the event days Identify appropriate spaces and dates Develop event programming and content Determine and purchase supplies and incentives Identify and enlist community partners Manage all publicity, community and patient outreach surrounding the events

6 Patient engagement Create communications to engage hypertensive patients in self-care activities and teach them how to work with their clinics to better manage this chronic condition. Create patient education materials for messaging team-based care services within Primary Care. Align with SFHN and clinic messaging efforts around heart health, especially the whole team approach, with posters, for example, and other patient-facing communication Develop multi-lingual educational and other patient-facing materials which reflect the health center and target communities. Create materials aligned with SFHN branding to support patients from high-risk communities to better access and navigate primary care and wellness services Design and manage system to effectively outreach to BAA patients. Partnerships Make recommendations for ongoing communications give professional analysis of strengths and areas for improvement Determine which community partnerships and CBOs would enhance and help draw people to the programs and events Develop and implement strategy to effectively disseminate materials partnering with key CBOs Determine which existing programs, events or relationships we can build on. A few examples include: Healthy Hearts SF program Sunday Streets Community Wellness Program at ZSFG Other community events, organizations or groups In your response please include: Your approach to the work including research, development, working sessions, community and stakeholder engagement, rollout plan etc. Timeline how long do you anticipate for each stage of the work: research, planning, communications, event management and follow up, or other phases Team and Resources. Please include resumes of the team members Approach to working with local experts and on-site teams at the clinics Demonstrated capabilities especially around project management, event planning and management and health care education Relevant experience including community-based health care, public sector, change management, and health education. Please include client names and project descriptions Demonstrated experience working in San Francisco neighborhoods including African American and Latino communities, and with community-based organizations and other neighborhood partnerships

7 Demonstrated ability and expertise in working with diverse groups, including race, language, sexual orientation, socioeconomic, lower literacy, differing language capability and cultural understanding. Our audiences are multi-lingual in English, Spanish, Chinese and Filipino, and sometimes other languages. Materials will need to be translated; please include specific information on your experience working with translation agencies or partners. VII. Project reporting and stakeholders This initiative is under the direction of the Rachael Kagan, DPH Director of Communications and Dr. Ayanna Bennett, DPH Director of Interdivisional Initiatives. Members of the DPH communications team will lead the work alongside the chosen partner. Executives from SF Department of Public Health, SF Health Network, and Community Health Equity and Prevention will also be involved as well as Zuckerberg San Francisco General Hospital CEO and Chief Communications Officer, and leadership from the San Francisco General Hospital Foundation. VIII. Process and Timing RFP issued September 22, 2017 Open conference call for questions: Tuesday October 3, 2017 Proposals received by October 10, 2017 In person meeting with finalists: Week of October 30, 2017 Partner (s) to be selected: By November 10 Work to commence soon after Executive sponsors Rachael Kagan and Dr. Ayanna Bennett will host a conference call to answer questions for all applicants. Tuesday October 3, 11 am Dial in Number Code: # IX. Budget The total budget is approximately $550,000-$700,000. These funds are to be used for all of the focus areas listed above including communication strategies, research, patient engagement, as well as running the community events. - Development of patient communications with hearth health patients - Planning, management, and execution of healthy heart events, possibly at four sites over two years - Community outreach to bring in partners and ensure high event turnout - Other event promotion Please apply for funding under specific focus areas. Include your proposed budget and breakdown of work within this range. Include examples of activities at each stage. Addendum: About the SF Health Network The San Francisco Health Network is a community of top-rated clinics, hospitals and programs operated by the Health Department. We connect San Franciscans to quality health care.

8 Every year we serve more than 100,000 people in our clinics and hospitals, such as Castro Mission, Chinatown and Southeast health centers and Zuckerberg San Francisco General and Laguna Honda Hospital and Rehabilitation Center. We provide continuous care for people wherever they are in clinics, hospitals, at home, in jail, transitional housing or on the streets. As the city s public health system we also provide emergency, trauma, mental health and substance use care to any San Franciscan who needs it. The Health Network celebrates the city s diversity, serving individuals and families of all backgrounds and identities, regardless of immigration status or lack of insurance. The Health Network is dedicated to empowering all San Franciscans, without exception, to live the healthiest lives possible.