Title: Emergency Department- Primary Care Connect (ED-PC Connect)
Organization: Primary Care Coalition of Montgomery County
Innovation Type: Care Connections
What They’re Doing: Connecting low-income patients from Emergency Departments to primary care physicians and medical homes.
Clinical Innovation: Primary Care Connect an integrated, coordinated referral system linking the five Montgomery County hospital emergency departments to four primary care safety-net clinics. Patients who are low income or uninsured or lack a primary care provider are referred to the program by Emergency Department staff and subsequently contacted by program staff who connect them with a medical home in a safety net clinic, assist them in scheduling an appointment with a primary care provider and educate them on ways to access care in non-emergency settings.
Evaluation Type: Quasi-Experimental
Evaluation Plan: The Hilltop Institute conducted an evaluation of the program that examined a cohort of 500 patients who enrolled in the program in 2009 and compare cost and utilization data for patients enrolled in the program vs. a comparable control group.
Patient Outcomes and Cost Data: ED-PC Connect successfully reduced avoidable ED utilization for project patients by linking them to clinics. The Primary Care Clinic confirmed these findings based on the full three years of the project. Clinic patients had far less ED utilization than patients who were never seen in the project clinics:
The greatest impact was demonstrated on patients with chronic and/or behavioral health conditions. During the three year period of the project, ED utilization by project patients with chronic health conditions was reduced by a projected 68%, resulting in an estimated cost savings of $670,000. ED utilization by project patients with behavioral health conditions was reduced by a projected 41%, resulting in an estimated cost savings of $230,000.
- Even before the referral process was implemented, patients with a prior clinic relationship were significantly less likely to have utilized the ED for any reason, and also less likely to have made a potentially avoidable ED visit. These findings illustrate the value of primary care access for vulnerable populations and suggest that the savings estimated during the project period will continue as relationships between patients and primary care clinics are established and maintained.
Other Data of Interest: Between July 2009 and December 2011, the EDs in Montgomery County identified and referred more than 10,000 low-income uninsured patients. More than 2,200 patients visited a clinic following referral, making more than 10,000 total clinic visits subsequent to their referrals. The clinics provided appointments within 30 days of their referral for the majority of patients. Two-thirds of patients that made an initial clinic visit returned to the clinic for additional visits. Patients diagnosed in the ED with hypertension and/or diabetes were likely to visit the clinic, while patients diagnosed with behavioral health conditions were less likely to do so. The most effective strategy in every partnership was a combination of a referral by the ED provider plus contact in person or via phone by a patient navigator.
Target Population: Low-income uninsured and Medicaid-insured patients seen in the EDs of the five Montgomery County hospitals.
Date of Implementation: July 2009
End Date: December 31, 2011. Final evaluation was reported in October 2012. A subsequent grant was awarded to specifically target patients who are high utilizers of ED services and have both chronic medical and behavioral health conditions.