Avoidable emergency department use not only places an enormous financial burden on hospitals and uninsured patients, it also adversely impacts patients’ health. Low-income, uninsured and Medicaid-insured patients who rely on hospital emergency departments as their regular source of medical care do not benefit from the preventive care, chronic care management, and continuity of care that they would receive in a primary care setting.
Approximately one-third of all visits to Montgomery County hospital emergency departments between 2005 and 2008 were made by patients who were uninsured or Medicaid-insured. These patients incurred more than $12 million in emergency department charges, $5.7 million of which were for avoidable ED visits, in FY 2008 alone.
The PCC began the Emergency Department to Primary Care Connect Project (ED-PC Connect) in March of 2009, after being awarded an Emergency Room Diversion Grant from the Centers for Medicare and Medicaid Services through the Maryland Department of Health and Mental Hygiene. The goal of the project was to reduce emergency department utilization in Montgomery County by referring low-income uninsured and Medicaid-insured adults from hospital emergency departments to safety-net clinics in order to link them to a medical home. To accomplish this, the PCC developed a coordinated referral system linking all five hospital emergency departments in Montgomery County with four safety-net primary care clinics: Holy Cross Health Center, Mary’s Center, Mobile Medical Care, and Proyecto Salud.
Between July 2009 and December 2011, the ED-PC Connect project referred 12,222 patients from Montgomery County hospital emergency rooms to Montgomery Cares clinics, and 2,257 of these patients made at least one subsequent clinic visit. Most of the patients who were referred to a clinic from the hospital emergency department had never before been to a Montgomery Cares clinic, but once introduced to the network of safety-net clinics they chose to return for one or more additional visits. Because these patients now had a reliable source of primary care, they did not continue to make unnecessary visits to hospital emergency departments.
ED-PC Connect greatly improved awareness of the Montgomery Cares program among low-income uninsured patients. The PCC supported the hiring and training of five patient navigators who were responsible for educating referred patients on the importance of appropriate emergency department utilization and informing them about resources available at Montgomery Cares clinics. By encouraging these individuals to seek regular primary care and linking them to an appropriate medical home, the ED-PC Connect project improved the quality, accessibility, and cost-effectiveness of the medical care that they receive.
Several of PCC’s hospital and clinic partners have described ED-PC Connect as one of the most meaningful and effective interventions that they have been involved in and have continued the project even after the ED-PC Connect grant expired.