In Ten California Counties, Notable Progress in System Integration Within The Safety Net Although Challenges Remain (Health Affairs)

Ten California counties have made great strides toward establishing a patient-centered health care system that provides access to coordinated and efficient care, but more work remains to be done. This Health Affairs article examines how effectively counties have transitioned from a fragmented safety-net model to an integrated health care network as part of the Health Care Coverage Initiative (HCCI). The article examines local health care coverage programs for low income adults in the counties from 2007 to 2011.

Both the article and a simultaneously released report highlight county advances in improving specialty access, quality of care, and health information technology.

For example, prior to HCCI, counties not all counties coordinated outpatient specialty care referrals, whereas under the new program they conducted extensive referral management. Counties also responded to challenges such as long wait times for specialty care by monitoring appointment wait times and patients' distance to specialists. Many counties also streamlined specialty referral systems to prioritize urgent referrals.

Progress in other areas was slower including the use of information technology. Most counties still relied on some paper records even when some electronic data systems were available. County efforts to improve use of information technology included implementing new systems, offering user support, and paying an incentive to doctors in the emergency department for entering notes.

Barriers to implementation of more information technology included high costs and the inability to compete with private organizations for trained information technology personnel. 

• Nadereh Pourat, PhD
• Anna C. Davis
• Erin Salce, MPH
• Dylan H. Roby, PhD
• Gerald F. Kominski, Ph.D.