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Updated: Regional Primary Care Clinic Stats from Final OSHPD Data

The final OSHPD primary care clinic data has been published and the statewide story, as told from the data, is very positive. The number of Medi-Cal managed care visits are up substantially (55%), the number of private (e.g. Covered California) visits are up (19%), and the number of uninsured visits are down (-28%). The decrease in uninsured visits includes declines in the number of uninsured visits covered by county funds (-77%) and the number of uninsured visits paid for out-of-pocket by uninsured patients (-19%). These trends, as conveyed by primary care clinics, are promising as it captures California’s uninsured population’s shift to becoming insured and fulfilling the intent of the Affordable Care Act.

Another layer to this historical health insurance shift is the substantial variation that exists across regions in the State. For example, the smallest increase in the number of Medi-Cal managed care patients was 37% in the Central Valley, whereas in the North Rural the increase is 220%, reflecting both the ACA expansions and the Medi-Cal managed care expansions happening in this area. Furthermore, the decrease in the number of uninsured visits covered by the counties ranged from -99.8% (North Rural) to -31.3% (Bay Area). These dramatic differences shed light on the nuances of California’s counties responses to health care reform.

Highlights of the data from each California region are below.

North Rural

  • North Rural had the highest decrease in uninsured visits (49%), closely linked to the high increase (46%) in Medi-Cal visits.

North Central

  • The county and MISP funded visits decreased by 99%.

Bay Area

  • The number of uninsured patient visits decreased only 18%. The decline was not as substantial as some of the other regions. Alameda County reimburses clinics for their care of uninsured Alameda residents.

Central Coast

  • The Central Coast clinics had the highest increase in private insured visits, likely Covered California plans, at 52%.

Central Valley

  • There was a large decrease, 31%, for uninsured patients that had to pay out-of-pocket for health care visits in the Central Valley.

Southern California

  • The patient visits covered by private insurance (Covered California) only increased by 11% in Southern California while their Medi-Cal managed care visits increased by 59%.

The increase in Medi-Cal managed care patients, coupled with the decrease in uninsured patients improved clinics’ bottom lines due the implementation of the Affordable Care Act. Statewide in 2014, clinics’ operating margins were $3.50 per primary care visit, up from just $0.21 per visit in 2013. Clinics in all regions, except Southern California, saw an increase in operating margins per visit, ranging from -$3.83 to $11.17, pre-ACA to post-ACA. Clinics’ revenue collected per visit increased 11% in the last year ($123.65 to $137.48). This is all positive news for primary care clinics that struggle to care for a patient population that presents with complex, acute health and social issues.

Final OSHPD data analysis for each region can be found here.