Los Angeles County’s municipal health system is the nation’s second-largest, annually caring for 600,000 patients at 19 health centers and four hospitals. In the past, the County’s Department of Health Services (DHS) struggled to bring insured patients back from out-of-network hospitals, with 15,000 to 20,000 patients being treated in other private facilities annually. The results were suboptimal patient experiences and increased cost to the county. To enhance patient care and reduce costs, DHS implemented a command center, known as the Transfer Center (PTC), to centralize operations for patient transfers, particularly repatriations from out-of-network hospitals. FUSE Executive Fellow Ernest Shahbazian helped launch the new unit, resulting in a 300% increase in repatriations during the first year of its operations.

Ernest focused on developing workflows, staffing plans, metrics, and reports. He also communicated the changes to internal and external stakeholders, including relevant leadership. The success of this initiative led DHS to implement local command centers at each of its four-county hospitals to improve communications and coordination. In the spring of 2020, DHS faced a once-in-a-lifetime challenge in the form of the COVID-19 pandemic, forcing the organization to pivot its operations. With so much uncertainty and rising infection numbers, Ernest helped PTC shift the focus from repatriations to helping load-balance bed capacity across the four DHS hospitals. The PTC moved patients to and from DHS facilities and coordinated transfers to external sites. It also repatriated 661 patients from out-of-network hospitals and coordinated 1,917 internal intra-DHS transfers, helping to decompress bed capacity across County hospitals. The PTC also performed 115 external transfers, further reducing the capacity strain caused by the pandemic.