Specialty Care Safety Net Initiative

The Specialty Care Safety Net Initiative (SCSNI) is a telehealth demonstration project that connects 38 safety net clinics across California with medical specialists at the five University of California Schools of Medicine.

Through the use of telecommunications, health information, and videoconferencing technologies, the SCSNI delivers medical specialty consults to patients in medically underserved communities—both urban and rural—where such services can be difficult or impossible to obtain. The SCSNI links safety net patients with UC physicians in six key medical specialties—connecting patients and medical professionals in offices as much as 600 miles apart.

The SCSNI serves as a laboratory to identify the means of establishing permanent relationships between UC medical schools and California’s safety net providers.

CCHP and SCSNI clinicians are working to discover the policy, statutory and practice pattern barriers that prevent widespread adoption and sustainability of telehealth services between UC medical specialists and safety net clinics. The SCSNI findings will help inform policy discussions on the long-term economic feasibility of these programs.

The SCSNI partners also are exploring new, innovative ways to apply telehealth technologies, to help improve the quality, safety, efficiency, and financial viability of specialty care for all Californians.

How SCSNI Works

The SCSNI is a collaborative among CCHP, the University of California, and 38 safety net clinics throughout the state. The project is programmatically sponsored by the University of California, Office of the President, and coordinated by CCHP. Funding for the SCSNI comes from the California HealthCare Foundation.

SCSNI partners include the UC Schools of Medicine at Davis, Irvine, Los Angeles, San Diego, and San Francisco, and participating safety net clinics. Each UC School of Medicine has a principal investigator, who oversees that school’s operations and research. For Phase 1 of the SCSNI, there are 12 safety net clinics statewide. Another 36 clinics have applied to join Phase 2 of the project.

The SCSNI:

• Purchases medical specialty clinic time from the UC Schools of Medicine in dermatology, psychiatry, orthopedics, endocrinology, neurology and hepatology. These specialties are ideal for the use of telehealth technologies, and safety net clinics statewide identify them as high-need areas for their patients.
• Reserves specialty telemedicine clinics for patients of SCSNI partners, allowing access to care for these patients, regardless of insurance status.
• Provides education services to SCSNI clinic providers, through UC physician-assisted patient consults and continuing medical education presentations.
• Provides limited financial support for SCSNI clinic and UC Medical School partners.
• Contracts with a telehealth technology consultant to provide support for each participating clinic.

The SCSNI currently uses existing telehealth networks, and eventually will use the California Telehealth Network (CTN). CTN will connect more than 850 California healthcare organizations to a statewide and nationwide broadband network dedicated to health care. CTN is funded by the Federal Communications Commission, the California Emerging Technology Fund, and UnitedHealth/PacifiCare.

Why Is SCSNI Needed?

Safety Net Patients Need a Reliable Source of Specialty Medical Care

Public and private clinics provide a “safety net” for low-income or uninsured patients seeking primary care, but there is no such safety net for those who need specialty care.

Patients needing specialty medical care are often left to navigate an uncoordinated array of medical specialists, many of whom do not serve Medi-Cal or uninsured patients.

For example:

• Merced County, a predominantly rural section of the San Joaquin Valley, is almost entirely dependent on out-of-town specialist referrals. For patients, this can mean time-consuming travel and missed appointments. A 2009 survey by University of California, Merced found that for about 80 percent of all patients who received such referrals, the number who actually followed through with appointments was less than 25 percent.
• South Los Angeles is a diverse, low-income and medically underserved section of Los Angeles, with roughly 1.1 million residents. A 2009 survey of physician wait times by Merritt Hawkins & Associates found that in Los Angeles overall, wait times for appointments in cardiology, dermatology and orthopedics averaged 11 days, 13 days, and 12 days, respectively. A 2007 survey of South Los Angeles by The California Endowment found that wait times for cardiology were six months to one year; dermatology, six months; and orthopedics, six months to one year.
• A 2008 survey of community clinics in San Diego County by the Council of Community Clinics found patient wait times of up to 6 months for pain management and neurology; up to 4 months for rheumatology; and up to 3 months for orthopedics, dermatology, and endocrinology.

California’s Health Care Leaders Need to Understand How to Make Telehealth Programs Financially Viable

Telehealth programs can facilitate timely, cost-effective access to medical specialists, particularly for safety net patients. They have proved popular with providers and patients alike.

But the majority of telehealth programs are not financially self-sustaining, and depend on grant support to maintain operations. Work needs to be done on the alignment of incentives, reimbursement, and business planning to develop sustainable models of care for telehealth. The SCSNI offers this opportunity.

The UC Schools of Medicine Make Up One of the Largest Academic Medical Center Systems in the United States

UC's five medical centers handle more than 138,000 inpatient discharges, 261,000 emergency room visits and more than 3.6 million outpatient visits each year. In addition, the UC Schools of Medicine comprise the nation’s largest health science and medical training program, with more than 13,000 students annually enrolled in 15 health sciences education programs.

The UC academic medical centers provide services essential to the health and well-being of the entire community, services which often are unavailable elsewhere—such as trauma, burn and cancer centers; high-risk obstetrics programs; neonatal intensive care units; cardiac care; and organ transplant programs. UC medical centers conduct a broad range of medical research, and develop and test new diagnostic and therapeutic techniques.

UC overall is the fifth-largest health care delivery system in California, with more than 34,000 health care professionals on staff, and one of the state’s two largest Medi-Cal providers.

Linking safety net patients with UC-based specialists holds great potential for addressing the unmet health care needs of California’s underserved populations.