Redesigning the Health System

In the next decade, California will need an additional 4,100 primary care providers to meet projected demand.¹

Although insurance provides access to care, it does not ensure that everyone receives appropriate or high-quality care at the right time.² An estimated 7 million Californians live in provider shortage areas, with shortfalls in access to primary, dental or mental healthcare providers.³ The shortage of health professionals impacts access to care, causing a significant delay in obtaining timely health services and resulting in barriers which negatively affect health outcomes. Access to comprehensive and quality healthcare services is important for physical, social, mental health, and overall quality of life.⁴ Access to care also promotes preventative measures, managing disease, and reducing unnecessary disability and premature death.⁴

This indicator tracks access to primary care providers based on the ratio of health professionals to population size. A primary care shortage area is defined as having a population greater than 2,000 per provider.

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Access to timely care varies across the state¹

This indicator tracks the percentage of patients receiving care in a timely manner, for both primary and specialty care.

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Californians need access to health care that reflects their diverse cultures and languages

For California’s diverse populations, ensuring that providers can engage with their patients in a culturally and linguistically competent way is essential to meaningful access.¹

Although there is currently no indicator to measure levels of access to Culturally and Linguistically Appropriate Services (CLAS), this has been identified as an opportunity for further data development to monitor this priority area of attention.

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Coordinating care improves health outcomes while controlling costs¹

This indicator tracks the percent of patients whose doctors' office helps coordinate care with other providers and services. Moving the system toward integrated and coordinated care allows patients to receive care in the most appropriate setting, reduces duplication, and enhances quality.²

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The nation spends billions annually on preventable hospitalizations¹

This indicator provides the rates of preventable hospitalizations (per 100,000 population) for selected conditions. It is based upon a composite indicator for twelve ambulatory care-sensitive conditions. Examples include diabetes complications, adult asthma, hypertension, heart failure, dehydration, urinary tract infection, and bacterial pneumonia. Hospitalizations due to these conditions are potentially preventable through access to high-quality outpatient care.¹

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California’s overall 30-day readmission rate has declined from 14% in 2011 to 13.5% in 2015.¹

The rate of unplanned hospital readmissions is an important measure of clinical quality. High rates may indicate concerns with low quality and are associated with high costs.² Fortunately, there is evidence that hospital readmission rates can be reduced using tested quality improvement methods.³ Typically, these interventions involve system transformation. Coordinating care between in-patient, outpatient, home, and community settings is a key component of high quality health systems.³

Patients’ demographic and economic status, social support structure, and multiple health conditions can increase or decrease the likelihood of being readmitted; though these impacts are not fully understood.

Note that this indicator is not risk-adjusted and differs in some ways from the Centers for Medicaid and Medicare Services (CMS) measure. Data are categorized by age, sex, race/ethnicity, expected payer source, and county of residence. (See metadata below for further details.)

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California spends $3.1 billion each year on hospital-acquired infections¹

This indicator includes incidence of measurable hospital-acquired conditions (per 1,000 discharges). This data is comprised of a composite patient safety indicator, which includes an average of the observed-to-expected ratios of several other selected indicators of quality. The available data is limited and there remains opportunity for further development to establish a more definitive measure. At present, this indicator serves as a useful starting point for examining hospital quality. With sustained and system-wide quality improvement efforts in hospitals, safety and quality of care for patients can be enhanced and billions of dollars saved.

Learn More » about Hospital Safety and Quality of Care (Acquired Conditions)