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Public Hospital Systems: Primary Source for Specialty
Care Services (For roundtable information, click here)
California’s 20 public hospital systems make up the core of the state’s medical
safety net – delivering care to all who need it, regardless of ability to pay, immigration
status or insurance. Though just 6 percent of all California hospitals statewide, public
hospital systems provide more than half of the hospital care to the state’s 6.5 million
uninsured. In addition to significant inpatient care, California’s public hospital
systems provide over 11 million outpatient visits per year.
Much of the care provided at public hospital systems is specialty care. In many communities,
public hospital systems serve as the main source of specialty care for Medi-Cal enrollees
and the uninsured. In fact, public hospital systems in California account for nearly
half of specialty care referrals to hospitals for patients seen at Federally Qualified Health
Centers. 1 Nationwide, half of the 31 million ambulatory care visits to
public hospitals are for specialty services. 2 With rising numbers of uninsured,
an aging patient population with multiple chronic conditions and a greater reliance on the
safety net, public hospitals are facing increased demand for specialty care.
To address this issue, many public hospital systems have begun to implement specific strategies
to increase access and reduce demand for specialty care services, such as e-referral systems;
greater coordination with primary care physicians; and developing clinical referral guidelines.
Specialty Care Access Initiative
In an effort to better understand the current state of access to specialty care and to
support movement within the safety net to ameliorate the problem, the California Association
of Public Hospitals and Health Systems (CAPH), the California Primary Care Association (CPCA)
and Kaiser Permanente (KP) have formed a partnership called the Specialty Care Access Initiative
(SCAI), which is supported by KP Community Benefit. Started in 2006, SCAI seeks to:
- identify barriers
to specialty care access and demand;
- establish solutions to increase specialty care access
and demand;
- distribute knowledge about barriers and solutions; and
- create an advocacy strategy
for needed change.
SCAI began its work towards accomplishing its goals through quantitative and qualitative
data collection. To gain an initial understanding of the specialty care access issue in California,
the Partnership hired Pacific Health Consulting Group to develop and gather data through
a statewide baseline survey. The data were collected from public hospital systems and CCHCs
and have helped SCAI begin to characterize the current state of specialty care access among
California’s major safety net providers.
Concurrently, SCAI began to collect qualitative
data by hosting statewide roundtable discussions. The roundtables are intended to provide
a forum to spread knowledge, share promising practices and increase networking between CCHCs
and public hospital system clinicians and administrators and other stakeholders. Having already
facilitated three roundtables that focused on E-health, E-referral and Scope of Practice,
the Partnership plans to host an additional three roundtable discussions in 2008.
SCAI is also beginning work on the collection of additional qualitative and quantitative
data through the development of three discussion papers that will focus. The first
discussion paper, completed in March 2008, addresses expanded scope of practice for primary
care providers. The other two will discuss (1) communication, coordination and collaboration
between safety net provider systems to address specialty care access; and (2) financing and
sustaining innovations in specialty care.
1 Felt-Lisk,
S., McHugh, M., Thomas, M. “Examining Access to Specialty Care for California’s Uninsured:
Full Report.” Prepared for the California HealthCare Foundation, June 2004.
2 National Association
of Public Hospitals, “Beyond Primary Care: Specialty Services at America’s Public
Hospitals and Health Systems.”
Materials and Resources
Round Table Forum #1: Developing and Managing Effective Referral Systems
Date: Monday, July 30, 2007
Location: Oakland, CA
Materials & Presentations: San
Francisco Referral Presentation; LA
& Santa Clara Referral Presentations; Minutes
Round Table Forum #2: E-Health
Date: November 5, 2007
Location: Burbank, CA
Materials: Save
the Date; Agenda; Attendees;
Presenter Contact Information;
Minutes
Presentations:
Alameda
County Blindness Prevention;
FHCN
Blindness Prevention; KP
Remote Telemonitoring; Maximizing
E-Health Options; Retinal
Telehealth
Round Table Forum #3: Scope of Practice
Date: March 6, 2008
Time: 10AM-3PM (lunch provided)
Location: Doubletree Hotel San Francisco Airport, 835 Airport Blvd.,
Burlingame, CA 94010, (650) 344-5500
Materials: Save
the Date; Agenda; RSVP
List ;March Roundtable
Notes; Discussion
Paper; Family
Practice Full Scope-Contra Costa; Timeline
for Expanding Scope of Practice-Shasta; Shasta
Case 1; Shasta Case 2; Shasta
Case 3; Diabetic
Referrals-Shasta; Orthopedics
Referrals-Shasta; Primary
Care Neuropsychiatry Services Work Efficiency Evaluation-Shasta; Model
of Care for Neuropsychiatry Services-Shasta; Ambulatory
Care Guidelines-Shasta; Expanding
Scope of Practice-Redwood Community; Community
Clinics Presentation-Marin; Homeless
Healthcare Program-Santa Clara Valley; Puentes
Clinic Article-Kaiser
Round Table Forum #4: Protocols and Guidelines
Date: June 17, 2008
Location: Sacramento
Materials: Save
the Date
Round Table Forum #5: TBD
Date: September 2008
Location: San Diego
Round Table Forum #6: TBD
Date: November 2008
Location: Burbank
For more information, contact:
Sarah Brooks, Policy Analyst
California Association of Public Hospitals & Health Systems
Phone: (510) 874-7101
Fax: (510) 874-7111
Email: sbrooks@caph.org
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