A success story for L.A. health care.

IF you've ever visited an emergency room on a Friday night, you may doubt that a successful model for delivering health care exists in L.A.. But it does: the Los Angeles County Public Private Partnership program. The PPP is a story about the public and private sector working together to deliver high-quality, cost-effective health care services to 1.3 million patients since 1998.

It started with a crisis. In 1995, Los Angeles County faced a $655 million budget deficit. The deficit was the result of skyrocketing medical and pharmaceutical costs, increasing demand for services, a growing uninsured population and unstable financing. To mitigate the pending financial disaster and prevent closure of public hospitals, the county pursued a novel strategy of offering private community clinics the opportunity to take over operation of public facilities.

Three community clinic agencies accepted the county's proposition, with the hope that funding would follow. And it did.

Los Angeles County was approved for a federal Medicaid waiver, providing much needed fiscal relief and an opportunity for new system reforms aimed at increasing primary and preventive care. Again, the county looked to the private sector--but this time as a means of expanding access to services in areas of high need. Within a year, 20 new contracts were signed with private non-profit clinics willing to either expand services at their existing sites or offer primary care services at county-operated clinics formerly providing only limited public health services.

Today, the PPP is a network of 54 community clinics and private physicians providing services at more than 100 locations countywide. The county pays PPP agencies a flat per-visit reimbursement rate that is substantially less than their cost. PPP providers leverage this funding with private dollars to offset costs and support basic health care services for the poor.

Primary care clinic sites for low-income, uninsured residents have more than doubled since 1995 and many partner clinics are open in the evenings and on weekends. These agencies have become the regular source of care for many uninsured patients.

The program has also led to major improvements in coordinating medical care. More than six out of every 10 PPP visits are for patients who have at least one chronic condition such as diabetes, hypertension, asthma, or congestive heart failure. With proper care, these patients can live healthy, productive fives.

Before the PPP program, uninsured county residents had limited access to routine health care and many patients had no choice but to seek emergency care for otherwise preventable and manageable conditions.

Today, patients with chronic diseases can be treated by a primary care provider at a clinic close to their home. Many PPP agencies offer comprehensive disease management programs that keep patients out of the hospital. In addition, patients can be referred directly to a county specialty care clinic through five newly established referral centers.

The county supervisors have made an ongoing financial commitment to the program through June 2006, meaning that, for the hundreds of thousands of residents that benefit from the partnership, being uninsured and poor is not an emergency situation.

Dr. Thomas Garthwaite is director of the Los Angeles County Department of Health Services. Man@ Johnson is chief executive of the Community Clinic Association of Los Angeles County.