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A New Script for LA’s Community Clinics

Today’s guest blogger is Louise McCarthy, MPP, President and CEO of the Community Clinic Association of LA County (CCALAC). 

Tonight CBS will debut a new show, “A Gifted Man,” which features the struggles of a doctor trying to keep a community clinic afloat amidst a host of clinical, operational, and personal issues. Is this reality television? While the show itself is fiction, it is rooted in the painful and promising drama in which LA’s community clinics and health centers now find themselves.

LA’s clinics are at a pivotal hour in their own personal drama—they have suffered Medicaid (Medi-Cal) cutbacks, celebrated healthcare reform and struggled to meet the demands of the newly uninsured. Now, clinics restlessly await the recommendations of the Federal Debt Reduction Supercommittee along with the annual Federal Appropriations process. All the while, they must enhance their operations in order to survive and thrive in the evolving health care marketplace.

For the television clinic, survival involves delivering a quality show, building a dedicated viewer base, earning strong ratings and studio support. For real-life clinics, survival is rooted in delivering quality care, building a strong patient base, transforming delivery systems, and maintaining public support for their programs. The challenge is great, but LA’s clinics are making progress:

· Delivering Quality Care: With the advent of health care reform, and the move toward transparency in health care systems, it will be critical for providers in any system to demonstrate the results they achieve for their patients. For over ten years, LA’s clinics have participated in a statewide quality improvement initiative, tracking data on diabetes, hypertension and adult preventive measures and gauging their patient outcomes against national benchmarks, such as the US Preventive Services Task Force. CCALAC Member clinics have demonstrated that despite serving a sicker population, they can meet, and sometimes exceed, the benchmarks. This year, we will begin publicly reporting this quality data at a statewide level.

· Building a strong patient base: CCALAC represents 46 nonprofit community clinics and health centers, serving nearly one million patients each year at over 140 sites across LA County. The vast majority, 87%, of LA clinic patients are under 200% of the Federal Poverty Level, and 62% of the patients are uninsured. We know that community clinics and health centers cannot serve solely an uninsured population: a 2008 regression analysis found that a clinic can sustain no more than 34.5% uninsured visits. To serve the uninsured, clinics in LA County must seek additional support through fundraising, grant writing, and county indigent care programs. With the expansion of Medicaid in 2014, over 550,000 Angelenos will become eligible for Medicaid, and 800,000 will remain uninsured. LA’s clinics have the capacity to serve the remaining uninsured, but as the regression indicates, that is not a sustainable proposition. They must be able to retain and attract the newly insured in order to keep services available to those who remain without coverage. Luckily, clinics are up to this challenge: through secret shoppers, patient satisfaction surveys, and involvement of patients in clinic governance, clinics across LA County are seeking patient input on their experience, and using this information to inform how they adjust their programs and services. These efforts will help clinics become providers of choice in the evolving health care system, ensuring their sustainability.

· Transforming Health Systems: Primary care does not exist within a vacuum. Clinics must transform their primary care practices in the context of the hospitals, specialists, and other providers that also care for their patients. Through partnerships with LA’s Departments of Health Services, Public Health and Mental Health, as well as key funders such as Kaiser Permanente and L.A. Care Health Plan, clinics in LA are working to reengineer our delivery system so that patients get better access to more comprehensive and appropriate care. Current efforts, such as LA County’s Healthy Way LA program, aim to strengthen the partnership between our public and private systems to better improve access and patient outcomes. Additionally, various telemedicine and tele‐mental health initiatives promise innovative approaches to specialty care access that will transform the patient experience.

· Maintaining Public Support: The above efforts will dramatically transform the ability of community clinics and health centers to meet the needs and desires of their patient population; however, we cannot ignore that the success of these efforts hinges in large part on Federal and State investments that are currently in jeopardy. The current budget debates in Sacramento and Washington threaten to fundamentally change funding for community clinics and health centers and the communities they serve: Federal support for the Medicaid program and the rules which currently prevent states from reducing eligibility, annual appropriations for Federally Qualified Health Centers, the National Health Service Corps, and many other key programs that encourage innovation and expand capacity to serve the underserved are all currently at risk. Clinics will advocate to strengthen our system to remain viable in the context of health care reform, yet they cannot do this alone. We ask that our partners join us in these efforts and advocate to maintain public support for these important programs (click HERE to sign up for CCALAC’s Action E-List).

Clearly, LA’s clinics are working mightily to build the foundation for the future; yet, every moment is pivotal in ensuring their survival. And so, like their prime-time counterpart, clinics are hoping that their performance today will get them “renewed” for another season.


CCALAC is the largest regional association of nonprofit community and free clinics in California.  Founded in 1994, CCALAC has 46 members that operate more than 140 clinics throughout the county.  These clinics serve nearly one million patients per year, the majority of whom are uninsured or underinsured.  CCALAC is dedicated to serving and representing the interests of its member clinics as providers of quality health care, including medical, dental and pharmacy services. For more information about CCALAC, visit www.ccalac.org or call (213) 201-6500.