Bridges to Care (B2C), a community-based program focused on coordinating care for high ED users, was able to cut ED visits and hospitalizations and boost use of primary care physicians—all in just six months, according to a study published in Health Affairs, Alexandra Wilson Pecci writes for HealthLeaders Media.
How it works
According to Pecci, Rutgers University Center for State Health Policy developed the program in collaboration with four different stakeholders in Colorado, including an academic hospital, a network of 13 local health centers, a mental health clinic, and a community advocacy organization. The program was funded by a CMS Innovations grant.
The B2C program focused on Medicaid-eligible patients who had made at least two ED visits or hospital admissions within the past 180 days. The program developed a 60-day care plan tailored to each participant's needs, including resources for housing assistance, refugee services, and transportation access. The program also helped participants with insurance and disability benefits applications, filling prescriptions, setting up doctor's appointments, and various other services.
According to the Health Affairs study, the participants after six months' enrollment in the program had:
- 123 percent more primary care visits;
- 30 percent fewer hospitalizations; and
- 29.7 percent fewer visits to the ED.
Why it works
According to Roberta Capp, an assistant professor of emergency medicine at the University of Colorado School of Medicine and part of the B2C team, the study debunks the idea that high ED users are often just "difficult patients." She explained, "This study shows that patients use the ED because ... there are serious barriers to care," such as dealing with multiple chronic diseases.
The researchers acknowledged that previous research has shown the benefits of care coordination, but they noted that other programs focused specifically on curbing avoidable ED use have had mixed results. "Many programs have tried to tackle the problem of high utilizers of hospital [EDs]. These are usually people who are on Medicaid," Capp said. "But this is the first program to show that care coordination actually works."
The reason it works, Pecci writes, is because the B2C program combines both active ED outreach with a variety of community-based programs. "We believe that our success stems from bringing together different health care systems, breaking down silos between disciplines, and focusing on continuity of care in the outpatient setting," Capp said (Wilson Pecci, HealthLeaders Media, 10/4).
How to reduce avoidable visits—in the ED and beyond
Heightened demand for emergency services and increased consumerism in health care has left emergency departments overburdened with rising costs and volumes.
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