“Camino de Salud Network” – A Regional Public-Private Integrated Delivery Network for the Safety Net

The lack of care coordination within the current US health care system has perpetuated staggeringly high costs, ineffective information flows, decreased quality of care, and poor health outcomes. As federal health care reform seeks to overhaul the current system, there has been renewed interest on integrated delivery networks (IDNs). IDNs are organized entities of healthcare providers collaborating to deliver coordinated, comprehensive health services within a given community. In order to address the endemic system fragmentation and health care access challenges faced by underserved communities within Central and Eastern areas of Los Angeles County, COPE Health Solutions (COPE) facilitated the development of a public-private IDN, now known as the Camino de Salud Network (CDSN) or Healthy Road Network. In 2005 the Los Angeles County-USC Healthcare Network (LAC-USC) in partnership with COPE, established the CDSN with the distinct goal of delivering the “right care, at the right place, at the right time,” promoting cost savings, increasing access to healthcare and improving health outcomes. The members of this network have grown to include LAC+USC, 4 private hospitals, 3 County comprehensive health centers, 12 community clinic organizations, the Keck School of Medicine at USC and the USC School of Pharmacy. Since its inception, CDSN has been tailored to address healthcare needs at a regional level by leveraging use of existing community resources and implementing the core principles of the IDN model: Increased care coordination by facilitating communication between inpatient, outpatient and specialty care services; emphasis on primary care by assigning a primary care home for all patients admitted to the hospital; standardization of care by adoption of specialty consensus care guidelines and mini-fellowship training for primary care providers (PCPs); and establishment of a dedicated advisory board for accountability and performance evaluation of the network. CDSN has successfully piloted restructured delivery of specialty care services in cardiology, rheumatology and gastroenterology through training and integration of PCPs in the delivery of these services as “specialty champions.” This decreased the number of avoidable referrals to specialty care clinics and increased access to specialty care and diagnostic services for community clinic providers. Additionally, decentralized diagnostic resources have been added in order to better enable the specialty champions to manage their chronically ill patient population. Here we discuss the framework of the Camino de Salud Network (CDSN), its remarkable successes, challenges and its significance for policymakers at both the local, state, and federal level.