Tangerine Brigham, deputy director of managed care services for the department, said she and her team want to create a system in which patients would have a consistent source of primary care—a specific physician or team that would know the patient's history and be equipped to administer preventive services to keep the patients out of hospital emergency rooms.
“We know that when people do not have access to a usual source of primary care, they'll go to the emergency room often,” Brigham said. “So our goal is to track utilization (of primary care services) over time.”
The new $61 million program was rolled out last Wednesday, and currently has 10,000 participants. Brigham said the county has budgeted for about 150,000 enrollees—she estimates that there are 400,000 uninsured individuals living in the county in the wake of the ACA.
Kyle Grazier, chair of the health management and policy department at the University of Michigan School of Public Health, said integrated approaches like My Health L.A. fill important gaps in coverage that will persist even with the Affordable Care Act.
“It increases access to people who didn't have it before, increases affordability for people who couldn't afford it before, increases efficiency and it provides them with preventive services that are provided under the Affordable Care Act,” Grazier said.
Grazier suggested the L.A. model could even help prevent the spread of the Ebola virus because immigrants are more likely to seek care from a primary-care physician when they experience early symptoms of the virus like diarrhea or vomiting.
Gabrielle Lessard, a health policy attorney at the National Immigration Law Center, said L.A. County has one of the highest municipal populations of immigrants living in the U.S. illegally. The Public Policy Institute of California estimated in 2013 that the county has nearly 900,000 such residents.
Fearing that they could be deported if they seek care in an emergency room, many immigrants resort to self-treatment rather than seeking a physician's care, but My Health L.A. has made progress overcoming that wariness. “The clinics have a long history of serving anybody regardless of insurance or immigration status,” Lessard said. “They're known for being trusted community partners.”
L.A.'s program is similar to the one administered by the city and county of San Francisco. Brigham, the L.A. county administrator, hopes that other municipalities will follow suit.
“We think and hope that other communities in California and elsewhere will see what aspect of this model can be replicated,” Brigham said.
Follow Adam Rubenfire on Twitter: @arubenfire