Investment in Team Care Approaches to Improve Access to Clinical Preventive Services in Los Angeles County, 2011-2014

background: As part of several federal initiatives to improve access to high quality, clinical preventive services (CPS) in local jurisdictions, the Los Angeles County Department of Public Health (DPH) partnered with a number of key health system partners in the area to advance the use of team care in ambulatory care settings. These partners at different stages of organizational capacity included the Ambulatory Care Network (ACN) of the Los Angeles County Department of Health Services; the community free clinics which worked with the Pasadena Public Health Department, Long Beach Health and Human Services Department and the American Diabetes Association (ADA); the LA Best Babies Network; and the Asian Pacific Liver Center at St. Vincent Medical Center. This program assessment compares and contrasts these various team care approaches at each health system venue and examines key factors that contributed to the models’ dissemination and potential sustainability.

methods: Multi-level program assessments were conducted in 2014 to describe post-team care implementation at each health system venue. Assessments included analysis of program administrative data (e.g., type and utilization of CPS), review of clinical records, and qualitative information on implementation processes (e.g., facilitators and barriers). Stages of team care implementation and progress were assessed for the period 2010-2014. 

results: Each health system venue was able to advance team care protocols in the ambulatory care setting, potentially affecting more than 250,000 clinic visits per year. For example, the ACN underwent a system-wide conversion to the patient-centered medical home model. The ADA expanded its Recognized Program, helping at least 4 large low-income health centers build staffing capacity and quality standards that are needed to receive reimbursements for services. Financial sustainability and limited organizational readiness were common factors identified by the health system partners as barriers to establishing team care.  

conclusion: Investment in team care approaches to improve CPS in Los Angeles County took on different forms depending on each partner’s needs and organizational structure. Lack of robust financial incentives and workforce interest to implementing team care remain major challenges to sustaining this health system strategy.