255005 Impact of the Health Care Coverage Initiative on low-income patients in Los Angeles County

Sunday, October 28, 2012

Karen Swanson, PhD, ScM , Office of Planning & Analysis, Los Angeles County Department of Health Services, Los Angeles, CA
Kimberly Brown, MSW , Office of Planning & Analysis, Los Angeles County Department of Health Services, Los Angeles, CA
Toki Sadralodabai, PhD , Office of Planning and Data Analytics, Los Angeles County Department of Health Services, Los Angeles, CA
Irene Dyer, MPH, MS , Office of Planning and Data Analytics, Los Angeles County Department of Health Services, Los Angeles, CA
Background: Healthy Way LA (HWLA) was implemented by the Los Angeles County Department of Health Services (LAC DHS) and its Community Partners (CPs) as part of the statewide Health Care Coverage Initiative on September 1, 2007. Patients were assigned to primary care clinic medical homes and given access to a 24/7 nurse advice line. An evaluation was designed to assess the impact of the HWLA Program on health services utilization and outcomes of care for the patients enrolled. Patient Population: Patients were required to be U.S. Citizens or Permanent Legal Residents for 5 or more years, Los Angeles County residents, ineligible for Medi-Cal, and have a family income lower than 133.33% FPL. By the third year of HWLA, there were 50,800 patients enrolled by DHS hospitals, Comprehensive Community Clinics, Health Centers and CP clinics. Methods: Data sources included the LAC DHS Enterprise Data Repository and patient claims data from the CPs. We acquired both Baseline and Year 3 data for 20,671 patients. All analyses were performed using SAS v 7.0. For DHS diabetic patients, lab data were analyzed to determine if there was an improvement in patient cholesterol, HbA1c and LDL results. Results: From Baseline to Year 3, hospitalizations decreased (1,599/1,000 members to 985/1,000.) The average inpatient length of stay decreased by 38%. Patients who only visited their medical home for primary care had over a three-fold decrease in ER utilization by year 3 compared to patients who visited other clinics as well as their medical home. Diabetics' cholesterol decreased by 41.2 mg/dL; p<0.0001. The 5.3 mg/dL decrease in LDL was not statistically significant. Diabetics' HbA1c decreased by 0.3 mg/dL; p<0.0001. Conclusion: Evidence for the first three years of HWLA suggests that the program made strides in improving the quality of health care received by our patients. The main findings—that ER and inpatient utilization decreased, certain quality of care indictors were met and/or exceeded, and that patients who only visited their medical homes visited the ER less than those who didn't— are consistent with the goals of this program. With the recent implementation of the Low Income Health Program, with its greater emphasis on access to timely care and strict enforcement of medical home primary care utilization, future analysis of HWLA should shed light on LAC DHS' ability to meet health care reform requirements and goals by 2014.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice
Program planning
Public health or related public policy
Public health or related research

Learning Objectives:
Describe utilization and quality outcomes for patients enrolled in the Los Angeles County Healthcare Coverage Initiative

Keywords: Access, Quality

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was involved in the planning and analysis of this program.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.