CAPH members are committed to providing high quality care to everyone in need, regardless of ability to pay. Despite the challenge of treating an ever-increasing number of patients, and doing so with limited resources, public hospital systems are leading efforts to transform health care delivery to be high quality, coordinated systems of care that are centered around the patient.
Care coordination is at the heart of an effective high quality health care delivery system and is critical to ensuring patients receive the right care at the right time in the right place. California's public hospital systems are leading efforts to improve care coordination by implementing and expanding medical homes, increasing operational efficiencies, redesigning primary care and patient visits, strengthening coordination between primary care, specialty care and behavioral health and improving technology.
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Public hospital systems strive to provide a coordinated system of care for all patients, by where patients receive health care services that are tailored to their specific health care needs and the collaboration between health care providers (i.e. primary care physicians, specialists, pharmacy, etc) is seamless. In order to provide this level of care to all patients, public hospital systems are engaged in multiple efforts to improve access to health care services, streamline coordination between different providers and improve health outcomes for patients. Furthermore, with a patient population that to a large extent is low income and has limited English proficiency, our members have redesigned many practices to be more efficient and address disparities in the delivery of health care.
Below are some of the specific efforts public hospital systems are engaged in to improve care coordination and health care quality.
Expanding Medical Homes
Patient centered medical homes are essential to providing coordinated and integrated care for a diverse, multilingual population with varying and often multiple health needs. Medical homes provide a central location or "home base" for patients so that they can be connected to primary and preventive care and also have access to a wide range of additional health services (i.e. specialty care, mental health, behavioral health, etc) that are tailored to address individual health needs. Medical homes also include a team of health care providers that work together in partnership with the patient to create an individualized care plan to improve health.
There are two major efforts underway to expand the medical home model within California's public hospital systems. The Incentive Program is a pay-for-performance quality improvement initiative that seeks to transform health care delivery in all public hospital systems, and 17 out of 21 public hospital systems are expanding medical homes as one of their Incentive Program projects. In addition to the Incentive Program, all public hospital systems participating in the Low Income Health Program, a coverage expansion effort underway throughout California, and are enrolling uninsured low-income adults into medical homes to help streamline and coordinate their care.
California Health Care Safety Net Institute
Since 1999, the California Health Care Safety Net Institute (SNI) has been the quality improvement affiliate of CAPH and has worked in collaboration with all public hospital systems to craft and implement programs that effectively improve patient experience, quality, access, efficiency and safety. SNI does this by providing technical assistance, facilitating learning sessions and workshops, and helping share best practices among public hospital members to collectively build upon and expand successful strategies. In addition, SNI works with other partners in California and across the country to share these best practices, lessons learned, and assist with other replication efforts. Specific improvement programs that have been implemented include: chronic care coordination, outpatient efficiency, language access, palliative care and health IT.
Through the Incentive Program, SNI will significantly deepen and expand this work with all public hospital systems throughout California.
For more information about SNI: www.safetynetinstitute.org
Health IT partnership - CalHIPSO
For the past several years, California's public hospital systems have worked to expand their use of health information technology, knowing that the meaningful use of electronic health records can result in significantly better health outcomes for their patients. However, its adoption has been hindered by high, upfront costs. But in 2009,public hospital systems received a helping hand in their effort to implement electronic health records that will allow them to deliver more coordinated and efficient care to their patients.
The HITECH Act of 2009 provides for the establishment of regional extension centers (RECs) across the country to help primary care providers with the training and technical assistance needed to achieve "meaningful use" of electronic health records systems. Subsequent to the measure's passage, CAPH, along with the California Primary Care Association and the California Medical Association joined together to form California Health Information Partnership & Services Organization (CalHIPSO), which was awarded a $31 million federal grant as the REC for most of California.
California's public hospital systems receive technical assistance through CalHIPSO for achieving certain electronic health record implementation related milestones. CalHIPSO does this by partnering with CAPH's affiliate, the California Health Care Safety Net Institute (SNI), which has established the Information Technology Adoption Center (ITAC) to help public hospital primary care providers take advantage of these new federal incentive funds. The grant will help defray the initial start-up costs associated with adopting this important technology.
For more information, please see the following materials: