Residents in the sprawling, 27,000-square-mile region of Southern California that includes Riverside, San Bernardino and Ontario have been hit particularly hard by the effects of the economic downturn and the collapse of the housing market.
And according to healthcare providers and policy analysts, home foreclosures and job loss in the area, often referred to as the Inland Empire, have led to rapid growth in the percentage of uninsured individuals and those dependent on the state's Medicaid program.
“Because of the very difficult times, the Inland Empire region has been affected even more than most,” says Dr. Bradley Gilbert, CEO of the Inland Empire Health Plan, a San Bernardino-based not-for-profit entity that manages government health programs for the state's low-income residents. “The timeframe for recovery here will be longer. And as people have lost homes and jobs, there has been a significant increase in the Medi-Cal population.”
Gilbert's views echo a July 2009 report about the Riverside/San Bernardino healthcare market, released by the California HealthCare Foundation. That analysis found that the recession had affected the region's
4 million residents “doubly hard” and has also put more pressure on hospitals that were already “financially vulnerable.”
Not much has changed in the two years that have followed, says Maribeth Shannon, director of the foundation's market and policy monitor program. In fact, the situation has likely worsened, she says.
“There really haven't been that many new developments in the market,” Shannon says, adding that the addition of a large number of newly insured individuals under health reform could add even further strain.
For officials at the Inland Empire Health Plan, managing the healthcare needs of more than 500,000 low-income adults and children—a number that has grown fast in recent years—poses serious challenges, particularly when so many patients struggle with multiple chronic diseases, income insecurity and issues accessing care, Gilbert says.
One strategy IEHP has employed is the use of a member history record, a one-page printable document with patient demographic information, lists of recent emergency-room and physician-office visits, lab tests, lab values and all known medications.
“It's a page-long summary of this patient's health record, as known to IEHP,” Gilbert says. “It's not totally complete since it's only our data, but it does provide a lot of information.”
That data is especially useful, he says, because few physicians in the region have electronic health-record systems.
The member history tool also provides physician offices with notifications regarding when patients are due to receive preventive services. In other words, an office can download data on one specific patient or data on the entire practice to see which patients are due for services such as mammograms, prenatal care, well-child-visits and immunizations.
The patient record service has been in place for about a year, but physicians' usage rates have been lower than IEHP had hoped, Gilbert says.
“It's not easy to get solo practices that are very busy to integrate this into their practices,” he says. “Once they have electronic health records, it will be a lot easier. But now it's a passive process and they have to download the information each time.”
To motivate physicians, IEHP has made available roughly $23 million in pay-for-performance incentive payments that reward use of the member history record and providing appropriate preventive screening services.
“If a physician brings a patient in for a Pap smear, we give a bonus payment,” Gilbert says. “We're trying to provide the data they need as well as financial motivation.”
Those steps are necessary to address the complex health needs of a low-income population whose numbers are increasing, he argues.
“The patients we serve don't have the same level of resources and they face a lot of barriers to care,” Gilbert says. “We need to have that extra help at the plan level and at the physician level to keep people healthy.”