In 2015, the Community Clinic Association of Los Angeles County (CCALAC) joined the Los Angeles Practice Transformation Network (LAPTN), an L.A. Care Health Plan initiative to help clinicians achieve large-scale health transformation. Across Los Angeles, the LAPTN deployed coaching teams to mentor and assist over 3,000 safety net clinicians in improving diabetes and depression care. CCALAC engaged 800 providers at 23 organizations under the PTN.
The success of the program has been immense: 587,795 lives were improved through clinical quality improvement, and care management. The program also helped prevent 58,105 hospital encounters that would have cost $136 million to the Medi-Cal program. LAPTN recently ranked fourth nationwide in the number of lives improved as well as the number of hospital visits prevented per clinician. The Transforming Clinical Practice Initiative (TCPI) is a Centers for Medicare & Medicaid Services (CMS) program aimed at transforming clinical practices, reducing unnecessary hospitalizations, building the practice transformation evidence base, and saving money in the health care system. Providers in the initiative have achieved these goals by applying best practices in patient activation, health education, staff satisfaction and retention, workflow redesign, and data integrity. To date, TCPI has saved the health care system $4.9 billion, with LAPTN accounting for six percent of overall savings.
John Wesley Health Centers Improves Diabetes Care Management
For John Wesley Health Centers (JWCH), the LAPTN fostered greater collaboration among the providers and staff, which has improved the organization’s care coordination efforts.
“Care coordinators can focus directly on our diabetic population as they make sure our patients attend their medical, nutrition, podiatry and retinal exam appointments,” says Denisee Alonso, a nutritionist at JWCH.
She recalls a 54 year-old female patient who had an abnormally high hemoglobin A1c (HbA1c). From late winter to early spring 2019, Alonso taught her how to incorporate physical activity and healthier meals into her diet. After the coaching, the patient’s HbA1c level had significantly improved, from greater than 10% to 6.5% (The American Diabetes Association notes that 7% is a goal for HbA1c). Another patient lowered their HbA1c level from 13.9 to 7.7 in the span of four months from January through April 2019.
In the future, Alonso hopes to see increased pre-diabetes and diabetes prioritization across clinics and more focus on nutrition advocacy for prevention. Overall, she remarks that JWCH – with their participation in LAPTN – has provided helpful resources to give comprehensive, quality care to their diabetic population.
HbA1c improvement is a high-priority outcome measure by CMS. Investments in training, data collection, and innovative care coordination through LAPTN has helped nearly 2,500 community clinic patients across with diabetes become healthier and gain control of their diabetes.
Workforce Changes at Family Healthcare Centers of Greater Los Angeles
In addition to improving clinical care by addressing patient conditions, LAPTN efforts also focused on improving clinic operations. Family Health Care Centers of Greater Los Angeles (FHCCGLA) targeted workforce recruitment and retention for their transformation. After implementing an incentive program, first-year attrition rates decreased by 17 percent.
“These changes have positively affected staff as they are more comfortable with their salary. As a result of this, more time is being focused on patients rather than having to train a new person every other month due to turnover,” said Azuree Smith, Human Resources Assistant at FHCCGLA.
She remarked that her LAPTN coach helped her make the HR department more efficient. The next phase of transformation at FHCCGLA will be to proactively track and understand reasons staff give for leaving the clinic via exit interviews. These efforts, as well as trainings on management and communication, will further improve workforce retention. Data on these interventions will be available later this summer.
Empanelment and Care Continuity at Wilmington Community Clinic
Wilmington Community Clinic (WCC) worked with the LAPTN to improve efficiencies in booking patient appointments and increasing patient engagement through empanelment to care teams.
“Empanelment, or the practice of assigning patients to a provider, makes clear to patients that they have a primary provider, which is important to many of them,” said Dr. Susan Ballagh, Medical Director at WCC. “Promoting continuity allows providers and patients to build trusting relationships.”
By linking patients to a specific care team, WCC can better monitor and hold their teams accountable for their patient outcomes.
After LAPTN, WCC will continue to work to improve their capacity to manage appointment demand, provider workload, and patient access to their care teams. The coaching team developed a comprehensive empanelment toolkit to support clinics in managing patient panels and promoting continuity of care with dashboards and automated analysis.
Sustainability of the Transformation Network
Cost savings is a core part of TCPI’s goals. Care management, empanelment, and workforce retention all contribute to cost savings.
Since LAPTN began, L.A. Care Health Plan saved nearly $140 million dollars in hospital claims for people with diabetes and/or depression. The LAPTN exceeded goals and aims set from the beginning of the project. According to CMS, LAPTN clinics consistently met goals on diabetes measures and were in-line with top-performing clinics in the country. In addition, improvement on screening for Body Mass Index (BMI) and Depression symptoms has increased 168% and 175%, respectively.
The 4-year LAPTN program will conclude in fall 2019. L.A. Care, CCALAC, and our partners are exploring opportunities to continue this work going forward. This includes future federal funding as well as policy changes to promote programs that incentivize continued transformation. For example, clinics and health plans across California are weighing the potential to reform how clinics are paid in the Medi-Cal Program. Instead of paying for only face-to-face visits with doctors, Medi-Cal could recognize the alternative visits and non-traditional providers that have made LAPTN a success.
Another example is the Health Homes Program, in which health plans identify high-risk patients with complex health needs and provide a higher level of payment to support enhanced care coordination. LAPTN helped prospective Health Homes providers form the infrastructure they need to participate in the program.
L.A. Care Health Plan is awaiting an announcement of a funding opportunity from CMS to continue this work. Given the success of LAPTN, CCALAC will continue to explore opportunities to support clinics in the areas of practice transformation, diabetes and depression care management workforce development and social determinants of health.