The transfer of uninsured patients from academic to community primary care settings.

Abstract

OBJECTIVES: To use the administrative capacity of a health maintenance organization to enroll uninsured patients at an academic health center into a coordinated care program in which patients were assigned to community primary care physicians over 3 years. STUDY DESIGN: Observational case study of a cohort of 2389 patients enrolled for at least 1 year and cross-sectional observations for all enrollees. METHODS: Among 18,336 eligible patients enrolled in the program between January 1, 2001, and December 31, 2003, a total of 2389 patients were continuously enrolled before and after the inauguration of the program. RESULTS: Over the 3-year study, most of the eligible uninsured patients were successfully enrolled in community-based practices. For the cohort studied, reductions were observed in the proportions of enrollees with inpatient hospitalizations (17.6% vs 13.8%) and with emergency department visits (73.9% vs 42.9%) (P <.001 for both). Although the rates of emergency department visits and hospitalizations were not reduced for the before-and-after cohort, utilization rates per 1000 enrollees declined for the overall program. CONCLUSIONS: Contractual arrangements with community physicians were used to augment primary care capacity for uninsured patients. Although per-member hospitalizations and use of the emergency department did not improve for the cohort studied, declines were observed for the program overall when examined by study year. Using community primary care physicians to coordinate care for the uninsured seems to reduce emergency department use and hospitalizations.