Primary care practices in the safety-net face increasing demands for services as the COVID-19 pandemic has elevated health awareness and state initiatives continue to expand Medi-Cal coverage. At Los Angeles General Medical Center (LA General), the largest primary care site within the Los Angeles County Department of Health Services (DHS), we noted that the years of deferred care, rapid primary care panel growth, and marked workforce attrition pushed our clinics to the breaking point. Primary care provider visits were backlogged, wait times for appointments were months long, and clinical outcomes and patient experience metrics were stagnant or worsening.

As the stewards of primary care access for nearly 58,000 patients across 9 unique medical homes, we heeded the call to disrupt the status-quo and began our journey to design and implement an alternative model of access to meet the competing needs of our patient population. Our vision was to use human-centered design methodology and understand the needs and experiences of all end-users. Our objective focused on developing an innovative solution that integrated medical home team-based care concepts and virtual health tools and technology to improve primary care visit capacity utilization (reduced % monthly visits not utilized, reduce % visit no-show, reduce third next available appointments [TNAA]) and balance clinical quality outcomes in our Quality Incentive Pool (QIP) Program and reported patient experience scores in the Press Ganey Medical Practice Survey (PG-MPS).