An intervention to connect low-income uninsured and Medicaid patients to a reliable source of primary health care shows promise for reducing avoidable use of hospital emergency departments in Maryland. A University of Maryland School of Public Health study evaluating the intervention was published in the May issue of Health Affairs.
For twenty years, use of U.S. hospital emergency departments has been on the rise, particularly among low-income patients who face barriers to accessing health care outside of hospitals — including lack of an identifiable primary health care provider. Almost half of emergency room visits are considered “avoidable.” The Emergency Department-Primary Care Connect Initiative of the Primary Care Coalition, which ran from 2009 through 2011, linked low-income uninsured and Medicaid patients to safety-net health clinics.
“Our study found that uninsured patients with chronic health issues – such as those suffering from hypertension, diabetes, asthma, COPD, congestive heart failure, depression, or anxiety – relied less on the emergency department after they were linked to a local health clinic for ongoing care,” says Dr. Karoline Mortensen, assistant professor of health services administration at the UMD School of Public Health and senior researcher. “Connecting patients to primary care and expanding the availability of these safety-net clinics could reduce emergency department visits and provide better continuity of care for vulnerable populations.”
Funded by a grant from the Centers for Medicare & Medicaid Services and the Maryland Department of Health and Mental Hygiene, the initiative engaged all five of the hospitals operating in Montgomery County, Md., at the time, and four safety-net clinics serving low-income patients. Using “patient navigators,” individuals trained to help patients find care, these hospitals referred more than 10,000 low-income, uninsured and Medicaid patients who visited emergency departments to four local primary care clinics, with the goal that they establish an ongoing relationship with the clinic and reduce reliance on costly emergency department care.
Two hospitals in Montgomery County who participated in the intervention continued the program after the initial grant period concluded because of the benefits they saw for patients and for reducing emergency department visits and associated costs.
While hospital administrators and health policy experts throughout the country are recognizing that access to primary care improves continuity of care for patients and reduces avoidable use of emergency departments, the implications of this project are particularly important for Maryland hospitals, which are operating under a unique all-payer model for hospital payments. Within this new payment structure, Maryland hospitals will have to meet ambitious spending, quality of care, and population health goals; reducing avoidable emergency department use can help in reaching these goals. The project provides promise not only for hospitals in Maryland but throughout the nation to improve health care experiences and outcomes for their patients.