Californians who depend on safety-net institutions for their health care often have difficulty accessing the specialty services they need, or may have to wait a long time for them. The hospitals, community clinics, and health centers that comprise the safety net face a number of barriers in providing access to many specialty services, particularly orthopedics, gastroenterology, neurology, and dermatology.

To better understand the size and causes of the problem, as well as to encourage effective solutions, Kaiser Permanente Community Benefit Programs partnered with the California Association of Public Hospitals and the California Primary Care Association in 2006 to examine specialty care access for uninsured and Medi-Cal populations. In 2007, Kaiser Permanente Community Benefit Programs and the California HealthCare Foundation came together to fund 28 planning grants and 23 implementation grants to regional provider coalitions across California to identify local barriers to care and develop strategies to improve access.

This report shares the findings from these activities. The goal of these efforts is to enable systemwide change and advance the larger goal of integrated community care in the safety net. More than half of the regional coalitions plan to implement one or more of five types of improvement activities, including:

1. Development and implementation of referral and/or clinical care guidelines;
2. Training for primary care providers, including expanding scope of practice to incorporate specialty care activities;
3. Expanded specialist networks;
4. Web-based referral or consult systems; and
5. Referral coordination improvements.

The complete report is available under Document Downloads.

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