Creating an integrated delivery network for Kern County

The Problem

Health care for the uninsured in Kern County was historically fragmented due to multiple geographic, organizational, and technological challenges. Public safety net providers in Kern County operated within silos, with few opportunities to coordinate services.

Faced with limited health care options, uninsured patients turned to the emergency department (ED) at Kern Medical Center (KMC) as their primary source of care, leading to high spending costs for treating patients that could have been otherwise managed with timely outpatient care (many of these visits were either for non-urgent care or acute care visits for preventable conditions).

The Solution

As part of the proposal development for the Medicaid Demonstration (Section 1115 Medicaid Waiver, 2006), COPE Health Solutions proposed a multifaceted strategy to improve clinical integration – targeting change at the system, organization, provider, and patient levels. Our team worked with KMC leadership to develop a vision to create an integrated delivery network, which became known as the Kern Medical Center Health Plan (KMCHP), to maximize the demonstration’s funding impact in the community.

Highlights of our approach:

• Planning, development, and implementation of the health plan: Wrote the initial proposal on behalf of Kern County to the State and negotiated the terms of the contract.
• Administration and ongoing management: Carried out all of the functions of a health plan, including creating screening and enrollment processes, conducting outreach to potential enrollees, processing claims, managing the contract with the state, tracking patient satisfaction, and performing ongoing data analysis for quality improvement efforts.
• Coordination of care: Authored and negotiated contracts between KMC and private community clinics to expand primary care access for patients, and assigned all KMCHP patients to medical homes. For frequent users of hospital services, we developed a Care Management Program to assist patients in accessing care more appropriately. Care between community clinics and KMC was enhanced through redesigning specialty care referral procedures and implementing a process for information sharing.

Results

KMCHP achieved demonstrable improvements in the quality, coordination and cost-effectiveness of health care delivery for Kern County’s safety net population. A formal evaluation by UCLA indicated that Kern was one of only two counties that demonstrated consistent decreases in both the rates of ED and inpatient visits between coverage initiative years one to three.

Moreover, the Care Management Program, which served patients who disproportionately accessed hospital resources, resulted in significant decreases in ED and inpatient utilization among Care Management Program patients. In recognition of the efforts to increase coordination and clinical integration, KMCHP was awarded a National Association of Public Hospitals (NAPH) Safety Net Award for Integrated Delivery Systems.