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3 ways to maximize primary care access for vulnerable populations

July 17, 2018

    Editor's Note: This blog is a rebroadcast of Get at the root cause of your primary care access problem. It may not be what you think, originally posted by Clare Wirth, Tomi Ogundimu, and Darby Sullivan. This rebroadcast is tailored for strategic planning audiences.

    Primary care is your system's front door. Not only does enhanced primary care access enable more patients to enter the system, but targeted access for at-risk patients can help reduce avoidable utilization, manage care in a low-cost setting, and prevent disease escalation.

    Learn key tactics for attracting and retaining patients to your outpatient site

    However, data still show that many vulnerable populations lack access to a regular source of care. And even when they do attempt to access the system, these patients miss or reschedule their appointments at higher-than-average rates. To engage these patients, planners need to target interventions at the principle barrier to access.

    We’ve identified three reasons why vulnerable patients may not make it to their appointments: 

    1. Logistical barriers, such as appointment timing or inconvenient clinic locations;
    2. Low patient concern over health maintenance due to housing or economic instability; and/or
    3. Poor transport access.

    Here's how three providers have targeted solutions at these three root causes of inadequate access.

    1. Maximize convenient care access points

    When Stanford Medicine noticed that 20% of its accountable care organization (ACO) members had not engaged with a primary care physician (PCP)—but had used the ED or urgent care—it launched focus groups to determine the root cause of the issue. These groups revealed that patients were interested in having a primary care relationship, but that they didn't feel the current options were convenient.

    In response, Stanford established 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).

    First-year results were promising: The virtual clinic achieved about a 30% cost savings relative to a typical primary care clinic, and a substantial amount of visits were shifted to the virtual setting. Overall, the Stanford team estimated that 55% to 60% of all 4,000 clinic visits were done virtually.

    2. Bring services to targeted locations

    For many low-income patients, routine primary care falls in priority compared with other issues, such as housing instability, food insecurity, and lack of insurance.

    Parkland Health and Hospital System in Dallas brings services to vulnerable communities by operating an extensive mobile health clinic program, serving almost 10,000 patients experiencing homelessness per year. Parkland's van parks at 31 convenient locations (e.g., housing agencies and food banks), where patients can receive medical, dental, and behavioral health care, as well as referrals and access to 35 different types of medications—all free of charge.

    3. Arrange transportation to bring patients to you

    Some providers have improved access by arranging non-emergency transportation to bring patients to them—a lower-cost alternative to bridge patients to their appointments than a full-scale mobile van.

    For instance, Cooper University Hospital partnered with RoundTrip, a rideshare startup, to provide patients with fast and reliable transportation. Cooper promotes the partnership on the hospital app as an easy alternative to driving and parking or finding a ride to the hospital. Patients are matched with the transport provider preferred by their insurance company; uninsured or ineligible patients are connected to rideshare company Lyft to schedule a ride to their appointment.

    Other providers, such as Valley Health, have launched in-house complementary ride services to bring patients into the system for care when they lack access to transportation. Look out for a profile on Valley Health's program in the upcoming weeks.

    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 drive volumes to your system.

    Learn more: Access our ambulatory strategies compendium


    Health systems need innovative strategies to drive patient volumes to their ambulatory network. Use these forward-thinking tactics to grow patient volumes at primary care clinics, urgent care centers, and other ambulatory sites.

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