Reimagining Emergency Care In California

Persistent calls for hospitals to address crowded emergency rooms and find solutions for underlying issues have demanded an urgent pivot toward alternative care models and expanded community health infrastructure.

These efforts aim to divert a significant volume of patients who — lacking reliable access to primary care — have come to rely on the emergency department as their primary health care contact for non-emergent, delayed, or chronic health concerns.

Further complicating things are the massive federal funding cuts under H.R. 1, which reduce hospital reimbursement rates and threaten to increase emergency room overcrowding by limiting resources available for essential patient care.

Federal funding cuts are also making it difficult for clinics and programs to address chronic health conditions and disparities faced by specific racial groups. This crisis in care access is not isolated; across California, emergency departments are increasingly becoming the de facto source of care for vulnerable populations struggling to find consistent medical support.

“For most of our patients managing chronic disease without consistent care access, we are not their last resort. We are their only option,” Dr. Mike Mesisca, department chair of emergency medicine at Riverside University Health System, says in a statement.

Stanford emergency physician Dr. Italo Brown sees this play out every day.

“The reality of the emergency department is that on any given day you are getting an array of different clinical presentations,” Brown says. “People come in often on days where it’s the worst day of their life, or they don’t have anywhere else to go, so you have to meet them where they’re at, regardless of what happened, and provide standard of care for everybody.”

Financial pressures make the search for innovative solutions even more urgent. As traditional hospital funding tightens, culturally competent care and community-based support are becoming essential strategies for building a more resilient and equitable health system.

Examples include WellSpace Heath; the free Imani Clinic, which is run by UC Davis medical students in Oak Park and addresses the medical needs of the African American community; and the Oakland and San Jose-based Roots Community Health Center, which originally was established to support underserved men — particularly those reentering society from prison, dealing with substance abuse, or lacking traditional support systems — by providing on-site medical care that improves accessibility and reduces unnecessary emergency room visits.

One Community Health’s Midtown Health Center provides an additional resource for urgent, non-life-threatening health needs to Sacramento residents through its walk-in services. By offering an accessible entry point for care that does not require an appointment, the center provides an option for patients seeking medical attention outside of the emergency department, with the goal of addressing non-emergent health issues in a primary care setting.

Addressing the rising volume of non-emergency visits from homeless patients, Sutter Medical Center implemented a Community Navigator initiative. Through direct street outreach, navigators are intended to build relationships with the local unhoused population to connect them with essential resources — including housing, substance abuse treatment, transportation, and primary and mental health care.

The Patient Navigator program — a collaboration between Dignity Health, Community HealthWorks and regional clinics — is designed to break the cycle of repeated ER visits. By embedding full-time navigators directly within the emergency department, the program is aimed at helping uninsured and Medi-Cal patients overcome barriers that drive them to the ER, such as benefits enrollment, establishing a medical home, and scheduling follow-up care. These navigators are meant to act as a vital bridge, transforming an emergency department visit from a temporary stopgap into a gateway for consistent, long-term health management.

Barbershop-based wellness efforts are another proven model. Brown serves on the board of T.R.A.P. ( Trust, Research, Access, and Prevention) Medicine, a Bay Area barbershop-based wellness effort that addresses the physical and mental well-being of Black males.

Locally, initiatives like Cut to the Chase and Cut the Chase Crown Edition (in beauty salons) host support groups and health screenings that provide care directly within the community. Cut to the Chase is organized by the Greater Sacramento Urban League. Members of the Capital City Black Nurses Association also lend their support. The nurses group previously hosted and participated in Barbershop Health Talks, a bicoastal platform and community event series that discussed health equity, mental wellness, and critical topics such as gun violence prevention and vaccinations.

Mercy San Juan, operated by Dignity Health, awarded Cut to the Chase a $100,000 grant in February 2025 for its work in Del Paso Heights and Oak Park.

Dignity Health spokesperson William Hodges also highlights the hospital group’s support for the Race and Gender Equity (RAGE) Project, which promotes Black youth well-being, and Folsom Lake College’s MESA program, which offers academic resources and mentorship to help women, low-income students, and people of color excel in STEM fields.

“While work remains to close health gaps, we are grateful for our community partnerships and the efforts we make together to create meaningful impacts on the health and well-being of Black communities in Sacramento,” he says.

New Developments

Locally, future capacity also will be bolstered by the Kaiser Permanente Railyards Medical Center, a $1.3 billion project in downtown Sacramento expected to open in 2029 with a new emergency department and 310 beds.

However, significant gaps in accountability remain. While Railyards Medical Center is a significant investment in physical capacity, the critical need for alternative care pathways is underscored by Kaiser’s own 2025 Community Health Needs Assessment, which ranks mental health, housing, and food security as top priorities for the region. Although the report offers valuable data — highlighting, for instance, that Black residents in Sacramento and Yolo counties face higher rates of food insecurity and more significant barriers to care — a critical gap remains in translating these insights into accessible, real-time public reporting that allows community members to effectively hold systems accountable.

Institutions such as Kaiser and Mercy San Juan outline substantial community benefit investments, but it remains difficult to determine if these programs are successfully narrowing racial disparities or improving outcomes for Black residents, who frequently rely on the ER as their primary care provider due to structural barriers — a reliance that further drains critical emergency resources.

In May, Derrick Boutte, an environmental services worker at Alameda Health Systems, was among stakeholders gathered at the Capitol to urge the inclusion of $500 million in the state budget to stabilize California’s 17 public hospital systems.

“I am very concerned that the patients my coworkers and I serve will have worse care options tomorrow than they have today,” Boutte, who also serves as East Bay President of SEIU Local 1021, said then. “With safety-net health systems moving to layoff critical staff, even if someone reaches a hospital for life-saving care, that hospital might not offer the same services tomorrow that it does today. Unless the state steps up, there will be devastating impacts to communities and families across California.”

Adaptive Response

A May audit showed that non-emergency, low-acuity 9-1-1 calls were burdening the city’s EMS system and straining emergency resources.

Expanding local resources and fundamentally changing emergency response protocols are seen as essential shifts. In response, Fire Station 140 in South Natomas now houses specialized alternative response units that handle non-emergency situations such as drug overdoses and mental health crises — something community groups have long advocated for.

The vehicles include SORT (Street Overdose Response Team), which focuses on opiate overdose calls; MIH (Mobile Integrated Health), which treats patients on scene and offers follow-up to make sure patients got the care they needed; and an MCU (Mobile Crisis Unit) that can transport people to mental health facilities or sobering centers.

“These specific units do not transport to the emergency departments, resulting in less impact on them,” says Capt. Justin Sylva. “Everyone that calls 9-1-1 for medical-related calls does not need to go to the ER, and having these resources available to treat them and get them to the right place reduces the impact on local emergency rooms.”

Not all units are in service at the same time and they currently only operate 8 a.m.-5 p.m. Monday-Friday. In June, they responded to 139 incidents.

“The hope is to grow the program as funding and resources become available focusing on the Community Medical Services rather than just on Emergency Medical Services,” Sylva says.

Global Medical Response’s associate chief medical officer, Dr. Gerad Troutman says emergency care doesn’t “start and end with lights and sirens." In June, Global Medical Response and others partnered with Stanislaus County to launch a 9-1-1 Nurse Navigation Program aimed at connecting callers with less critical medical needs to alternate paths for care while keeping emergency resources available for life-threatening emergencies.

“Gaps in health care access are increasingly showing up as 9-1-1 calls. In our county, more than 1 in 3 residents can’t find a local provider,” Daniel Iniguez, regional director for American Medical, Response says in a statement. “Stanislaus 9-1-1 Nurse Navigation helps us respond more intelligently by connecting patients to the right care while preserving emergency resources for those who need them most.”

Health care experts emphasize that by connecting callers to appropriate care pathways from the very first point of contact, nurse navigation represents the next step in creating a more responsive and patient-centered emergency system.

These models aren’t without challenges. Similar programs in cities such as Seattle have faced criticism for long wait times and potential delays in care for patients who are incorrectly triaged, highlighting the risks inherent in navigating complex medical needs over the phone.

Ultimately, health care experts emphasize that building a resilient health system requires more than just expanding emergency capacity; it demands a fundamental shift toward community-centered care that addresses the social drivers of health long before an emergency call is ever made.