Serving more than 2.85 million patients annually, primarily Medi-Cal and uninsured, California's 21 public health care systems are on the front lines of implementing health reform. In this newsletter, we hope to offer a window into that experience.




A few months into 2014 and one open enrollment period under our belts, and it is clear that coverage expansion in California is off to an impressive start. More than 3 million Californians have benefitted from the Affordable Care Act through enrollment in Covered California and Medi-Cal, and millions more are eligible for coverage but not yet enrolled.


While we have seen rapid surges in enrollment, it will take time to see what impact these changes have on local patterns of demand for health care services. Some of the newly insured, with pent up demand, will seek care right away, whereas others have already been receiving the care they need from safety net providers like public health care systems and community clinics that deliver high quality care to all who need it, regardless of ability to pay or insurance status. Others who have recently gained insurance may not have a need for health care services today, but will surely show up when they do.


As the number of Californians enrolled in new coverage continues to grow, ensuring adequate access will be a major priority for health care providers throughout the state. Efforts to redesign care and increase efficiency have become more important than ever. In the experience of California's 21 public health care systems, efforts to expand access to serve new patients can also improve care for current patients. For example, the Los Angeles County Department of Health Services (LACDHS), replicating success in San Francisco, has begun using a web-based portal called eConsult, in order to reduce wait times for specialty care services and improve communication between primary and specialty care providers.


The portal facilitates a structured, back-and-forth discussion that makes it easier for primary care providers and their specialist colleagues to confer over a patient's medical issues and work together to quickly resolve them. Primary care providers consult a specialist by sending a secure message through the portal. Within a few days, the reviewing specialist responds to provide education and advice to continue caring for the patient in his or her primary care medical home, request additional information and tests, or immediately schedule an appointment with the patient.


"Often, patients can be adequately cared for by their regular doctor with advice from the specialist and that leaves room for specialists to more quickly see the patients who really do need them. We have seen a 50 percent drop in wait times at most of our specialty clinics," says Dr. Alice Chen who oversees a program similar to eConsult, known as eReferral, at San Francisco General Hospital and Trauma Center. Originally piloted for gastroenterology services in 2005, the program is now used for more than 40 specialty services and has inspired other safety net systems across the state, nation and even abroad to pursue similar efforts.




eConsult patient, Albert Williams. See his full story here.

More than 70,000 eConsults have been conducted connecting primary care providers and specialists across Los Angeles County to better serve patients with specialty care needs. LACDHS is working to add more specialties so that all patients can receive the kind of timely and coordinated care that leads to success stories like 57-year old Albert Williams. Just two months after being diagnosed with colon cancer as a result of his primary care doctor consulting a specialist, Mr. Williams underwent surgery to remove the tumor. Today he is cancer free, thanks to his health care team and the quick diagnosis and treatment facilitated by eConsult.



Tools like eConsult and eReferral are one of many strategies that California's public health care systems are employing to provide improved care in an environment of expanded coverage. These strategies hold great promise for expanding access to the newly insured and providing all patients with better care at the same time.



CAPH is a non-profit trade association that represents California's 21 public health care systems - comprised of county-owned and operated facilities, and University of California medical centers. In partnership with our quality improvement affiliate, the California Health Care Safety Net Institute (SNI), we work to strengthen the capacity of our members to advance community health, ensure access to high-quality, culturally sensitive health care services for all Californians, and educate the next generation of health care professionals. For more information, visit us at or