How can all Californians achieve access to affordable, high-quality healthcare?

What drives Access to Quality Care?

Quality health care is consistent, affordable, patient-centered, timely, and delivered in a linguistically and culturally competent manner.1 Even with many organizations working towards a common goal, there are still disparities in quality of care for certain populations.

Although insurance provides access to care, it does not ensure that everyone receives appropriate or high-quality care at the right time; nor does it fully address the remaining financial barriers to access for low-income people with insurance.2 Factors such as distance to care, transportation, time off work, child care, and other out of pocket costs impact access to care for Californians.

Racial and ethnic minorities and individuals with low household incomes are also more likely than their non-Hispanic White and higher-income counterparts to experience culturally insensitive health care and dissatisfaction with health care – health care experiences that have been linked to poorer health outcomes.2 Disparities in mental health services are also found among all races, ethnicities, sexual orientations, and gender identities and expressions.5

Quick Facts

  • The Institute of Medicine’s report Unequal Treatment indicates that U.S. racial and ethnic minorities are less likely to receive routine medical procedures and more likely to experience a lower quality of health services.2
  • California ranked 20th among all states for overall quality of care for low-income patients.2
  • Even though they make up the majority of the state’s population, communities of color are less likely to receive quality mental health care services than their Caucasian peers.5
  • Members of the LGBTQ community frequently report that mental health providers do not know how to address sexual orientation and gender identity concerns, or overemphasize these issues in treatment, even if it is not the reason the person sought care.5

The Opportunity

Measuring the quality of health care is multi-faceted. It takes many institutions working together to create a holistic high quality experience for all patients. In order to achieve higher quality of care in California’s public and private health care sectors, we must provide services that are responsive to the cultural and linguistic needs of California’s diverse population.2

What’s being done?

Here are just a few examples of efforts underway at the state and local level to address this issue:

State Efforts

Public Hospital Redesign and Incentives in Medi-Cal (PRIME)
The California Department of Health Care Services (DHCS), which administers and manages Medi-Cal, California’s Medicaid program, is committed to continual improvement in population health and health care in all departmental programs.3 One of the projects that is part of the DHCS Strategy for Quality Improvement in Health Care is the Public Hospital Redesign and Incentives in Medi-Cal (PRIME).4 PRIME builds upon the foundational delivery system transformation work, expansion of coverage, and increased access to coordinated primary care from the Delivery System Reform Incentive Payments (DSRIP) Program, as a component of the new federal 1115 Medicaid Waiver.4

[Read more]

Local Efforts          

Santa Rosa Community Health Center
The program uses a Nurse Practitioner Care Team to extend the primary health home into hospitals, skilled nursing facilities, and patient homes to improve health outcomes and reduce costs. Care Teams use a combination of home visits, health center-based services, and phone check ins to assess patient conditions, monitor health status, and deliver treatments. Visits include a significant focus on patient education and self-management skills, with the goal of better self-management of chronic disease, preventing relapse and avoidable secondary conditions, and reducing hospital and ER utilization. This approach combines comprehensive discharge planning with intensive follow-up interventions that incorporate patient goal setting, individualized care planning, educational and behavioral strategies, psycho-social interventions, direct links to community support, and clinical management. Santa Rosa Community Health Center is a 2015 Innovation Challenge Finalist. [Read more]

Check out even more in the Innovation Challenge Showcase.

Links and Resources


  1. Integrated Healthcare Association. (July 2016) California Regional Health Care Cost & Quality Atlas. California Healthcare Foundation, from
  2. Office of Health Equity. (August 2015). Portrait of Promise: California Statewide Plan to Promote Health Equity and Mental Health Equity. California Department of Public Health, from
  3. Department of Health Care Services. (April 2016) DHCS Strategy for Quality Improvement in Health Care, from