Dear UCR Health Community, 

Earlier this year, I attended Riverside Mayor Patricia Lock Dawson’s State of the City presentation, and I was truly impressed with Riverside's growth and the developments within the community. The City of Riverside has identified areas for reinvestment and transformation into hubs of art, commerce, and cultural diversity. It is thrilling to see a promising future with a population that keeps increasing, establishing more businesses, and relocating to the Inland Empire. 

As the Inland Empire continues to grow, so does the demand for healthcare services. With a population exceeding 4.7 million and projected to surpass 5.1 million by 2030, our region faces increasing challenges in healthcare access and coordination. One of the most pressing issues we are working to address is provider fragmentation. 

Provider fragmentation occurs when patients receive care from multiple providers who are not coordinating with one another. This leads to duplicate tests, unnecessary emergency department (ED) visits, hospital readmissions, and poorer health outcomes. Patients, especially those managing chronic conditions, often struggle to navigate a system that lacks continuity, making it harder to receive timely, effective, and affordable care. Examples of how this can manifest include: 

• Being "ping-ponged” back and forth among providers 
• Having medical records that are inconsistent 
• Inability to contact providers for prescription refills 
• Being unable to locate referrals 
• Being unable to access solid and reliable information about our medical conditions on a trustworthy website 

The Inland Empire also faces unique challenges that lead to provider fragmentation, including a shortage of primary care providers, overuse of emergency rooms for incidents that could have been addressed through better primary care, and socioeconomic issues that create vulnerability. In order to address these challenges, it is crucial is important to incorporate metrics that highlight supporting data:

• Primary Care Shortage: Many residents have difficulty finding a consistent primary care provider, with a patient-to-provider ratio of 1,701:1 in San Bernardino County and 2,270:1 in Riverside County, compared to the state average of 1,240:1. We also have the lowest rate of primary care physicians per 1,000 patients at 41, which falls short of the target of 60-80. (Source: CHCF.org) 

• High Emergency Department Utilization: The region reports 403 ED visits per 1,000 residents, surpassing the state average of 377 visits per 1,000 residents. Many of these visits could be prevented with better access to primary care. (Source: CHCF.org) 

• Hospital Readmissions: Although California’s 30-day readmission rate stands at 13.5%, numerous Inland Empire hospitals report rates at or above this threshold, highlighting the necessity for improved care transitions and follow-up services. (Source: MedPac) 

• High Medi-Cal Enrollment: San Bernardino County’s Medi-Cal enrollment increased by 86% from 2013 to 2022; however, challenges related to provider reimbursement have resulted in gaps in access to care and coordination. (Source: California DHCS). 

• Social Vulnerability Index (SVI): With SVI scores of 0.7104 for San Bernardino County and 0.5372 for Riverside County, many residents encounter economic, language, and transportation challenges, which worsen healthcare fragmentation. This metric indicates that residents of San Bernardino County are more vulnerable than 71.04% of counties nationwide, while those in Riverside are more vulnerable than 53.72%. These findings are quite alarming. (Source: CDC) 

At UCR Health, we recognize that provider fragmentation is not just an administrative challenge—it is a critical healthcare issue that affects patient outcomes, provider efficiency, and the overall health of the community. That’s why we are launching several initiatives to improve coordination and expand healthcare access in the Inland Empire: 

• Expanding Primary Care Access – UCR Health is increasing the number of primary care providers in the region, enhancing telehealth services, expanding online scheduling, developing new clinical sites to address the needs of our growing patient populations. 

• Enhancing Care Coordination – We are refining patient referral processes, strengthening collaboration with specialists, and integrating care navigation teams to help patients transition between providers more smoothly. 

• Utilizing Electronic Health Records (EHRs) for Improved Communication – By enhancing EHR interoperability, we ensure that patient records are shared effectively among providers, improving care continuity. Additionally, we have enhanced our EHR functionality to enable direct communication with you, refill your medications, address any quick questions you may have, and follow up after your visit. 

• Developing Community-Based Programs – We are improving patient outreach, health education, and chronic disease management initiatives to help at-risk populations access proactive care before health issues escalate. 

• Strengthening Partnerships – UCR Health is collaborating with local hospitals, community health centers, and policy organizations to advocate for enhanced funding, provider incentives, and care delivery models that reduce fragmentation. We recently implemented a system called FindHelp, which connects patients with community service organizations to assist with their non-clinical needs, including housing, transportation, and nutrition. 

At UCR Health, we view fragmentation as an obstacle to achieving excellence—which means providing you with outstanding care. As we grow, we will continue to make your health our top priority. 

We are dedicated to delivering high-quality, coordinated care to the residents of the Inland Empire. This includes investing in solutions that enhance patient experiences, streamlining provider workflows, and ensuring that every patient receives the right care at the right time and in the right place. 

We invite you to join us in this effort—whether you are a healthcare provider, a patient, or a community advocate. Follow us on Facebook and Instagram for updates on our initiatives, upcoming healthcare programs, and ways to get involved. 

Together, we can bridge the gaps in care and build a stronger, healthier Inland Empire. 

In Health,