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Get at the root cause of your primary care access problem. It may not be what you think.

June 12, 2018

    One of the core strategies of driving ROI in risk-based contracts includes reducing unnecessary utilization by trading high-cost care for lower-cost services. For this shift to occur, patients must have access to a consistent source of care—but data show that many vulnerable populations do not. With 25% of low-income patients missing or rescheduling appointments, providers need to have a clear sense of the root cause of primary care underutilization. In our research, we found three reasons why inactivated patients may not make it to their appointments: 

    June 13 webconference: Improve access to care for the underserved—with mobile health clinics

    1. Deprioritized health maintenance due to housing or economic instability;
    2. Logistical barriers, such as appointment timing or inconvenient clinic locations; and/or
    3. No access to adequate transport.

    To engage at-risk patients with inconsistent touchpoints to the health system, target interventions at the principle barrier to access. Here are three providers that have done that.

    Bringing full scale services to targeted locations

    For patients who struggle with housing instability, food insecurity, even insufficient wages, or lack of insurance, it's no surprise that primary care is near the bottom of the to-do list. These variables together often mean providers must bring the full scale of those services into the community, meeting patients where they are.

    Parkland Health and Hospital System in Dallas does this by operating an extensive mobile health clinic program, serving almost 10,000 patients experiencing homelessness per year. To reach these patients, Parkland parks outside of its 31 community partners' locations (e.g., housing agencies and food banks). Once patients enter the van, they receive a suite of services, including medical, dental, and behavioral health care, as well as referrals and access to 35 different types of medications—all free of charge.

    Maximizing convenient care access points

    In 2014—when Stanford Medicine noticed that about 20% of its ACO members had not engaged with a PCP but used urgent care or the ED—the health system got to the root cause of primary care disengagement. Focus groups revealed that these members were interested in having a primary care relationship, but the current options weren't convenient enough.

    In response, Stanford established what the health system refers to as a "virtual primary care clinic" called ClickWell Care. In this model, the first visit is in-person. After that, patients have the option for subsequent visits to be done virtually (over video or the phone). Results were promising in the first year. The Stanford team estimated that 55% to 60% of all 4,000 clinic visits were done virtually, with the remainder done in person. Further, the virtual clinic achieves about a 30% cost savings relative to a typical primary care clinic.

    Arranging transportation to bring patients to you

    For communities where patients who need transportation into primary care are geographically dispersed, providers can improve access by arranging non-emergency transportation to bring patients to them.

    To support seniors' transportation needs, ElderCare of Alachua County, an affiliate of UF Health, partnered with Uber to create the "Freedom in Motion" program in Gainesville and Jacksonville, Florida. Wells Fargo and the local government contributed over $20K to purchase smartphones for participants and subsidize rides for seniors. As a result, each senior received a phone with a custom-built Uber app, training on how to use it, and affordable on-demand rides ($0-5 per ride, dependent on income level). Three months into the project, the 28 participants used the service 170 times.

    What's next for your organization?

    Find out the underlying reason why your patients aren't accessing the care they need, and tailor your intervention accordingly. No matter the method, the goal stays the same: get proactive by increasing patient touchpoints to stabilize and deescalate those who are at-risk.

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