The Montgomery Cares program (MCares) served 22,693 Montgomery County residents in fiscal year 2023, providing last-resort access to care for residents with incomes at or below 250% of the federal poverty level who do not qualify for state or federal healthcare access programs. Understanding the proportion of patients that maintain program participation year over year helps PCC and MCares program partners gauge how well we are meeting patient needs and where there might be areas for improvement.
We first explored overall trends in the data, which PCC data analysts extracted from MCares billing records for the fiscal years (FY) 2015-2023. The results show that while the overall number of patients participating in the program is largely steady, the individual patients participating in the program are not. Around 50% of individual patients stay with the program from one year to the next.
While the ideal is for every patient to have an annual primary care visit, we know that is not the reality for many adults—insured or not. Because MCares participation is defined by care usage, rather than by annual enrollment (as is the case in insurance participation), retention rates alone cannot tell us how many patients stop participating because they remain free of health concerns and how many stop participating because of access challenges.
To explore that question, PCC looked at participation according to the ICD-10 diagnoses included in billing documents (and verified in the electronic health record for the six clinic organizations that use a PCC-maintained system). PCC compared retention rates for patients with chronic conditions to those without a chronic condition from FY2020-2023. We found that 88.1% of patients who participated in each of those years had a chronic condition. Among patients who participated for a single year, only 44.6% had chronic conditions. When we looked at the number of chronic conditions among the most enduring patients, we found that 69.9% of four-year participants had three or more chronic conditions, versus 35.7% of one-year participants.
Combined, these results suggest that patients with more complex health needs are more likely to continuously participate in the program than patients with less complex needs, which makes intuitive sense. However, it does not tell us what happened to the patients with complex health needs who have limited program participation. That matters because these are the patients who need to be receiving care, and we want to know if they are. Studying data from the Chesapeake Regional Information System for our Patients (CRISP)—Maryland’s health information exchange—might help answer that question.
This article has not been reviewed by the Montgomery County Department of Health and Human Services.
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