At the PHPDA we continually seek sustainable ways to improve access for the underserved in our local community. We have supported a number of initiatives over the past few years to learn more about the everyday barriers to health care access for the uninsured. Here is some of the information we’ve been gathering:

Removing System Barriers

Specialty Providers: Barriers to Successful Referrals (2007)

Summary: This study looked at unintentional barriers to appointments created by providers who agree to see uninsured patients.

Results:

• Simplification of eligibility requirements for specialty services
• Training and regular meetings of safety net referral coordinator staff
• Improved communication between safety net clinics, Pacific Medical Center (PMC) and King County Project Access (KCPA)
• Development of a community-endorsed eligibility application for patients referred to either PMC or KCPA.

In 2007, fewer than half (42%) of uninsured patients referred for specialty care successfully received appointments at either PMC or through KCPA. By the end of 2008, the average percentage of successful appointments had increased from to 73%.
More info...

Safety Net Clinics: Barriers to Successful Referrals  (2009) 

Summary: Now that there is increased efficiency from King County Project Access and Pacific Medical Center for specialty care appointments for the uninsured, why aren’t there more referrals from the safety net clinics? What are the unintentional barriers they create?

Results:Initial review of the data demonstrated that more than half of the specialty referrals are sent to providers other than KCPA and PMC. There is no data kept on whether these patients are successful is being seen by these providers or even whether the referral was successfully received. At the end of 2009, the PHPDA and HealthPoint Community Health Centers are looking at a pilot project to design a more effective specialty referral process.

Safety Net Clinics: Small Changes Reap Big Rewards (2010)

In 2010, the PHPDA initiated a pilot with HealthPoint Community Health Centers to track referral outcomes and look for process improvements that a community health center could make readily. The HealthPoint Federal Way clinic team was the pilot team.

Here’s what we learned about Safety Net Clinic Referrals in 2010:

• Some patients need one-on-one assistance in scheduling a specialty appointment. Our analysis showed that more than 34 percent of patients were asked to schedule their own appointment—including populations that truly needed scheduling assistance. Clinic staff believe they should meet one-on-one with the following patients to help arrange for an appointment: patients who are uninsured, homeless, need assistance with language or literacy, or need an urgent specialty care referral.
• Modifications to the electronic medical record can solve some of the problems with incomplete referrals. By funding a few small changes in the NextGen electronic medical record, such as drop-down menus and a limited free-text option, the Pacific Hospital PDA was able to help safety net clinics make referrals more easily and measure them more efficiently.
• Guidelines for primary care providers help ensure that patients referred to specialists have the needed tests, imaging and preparation. By contracting with King County Project Access (KCPA), the Pacific Hospital PDA was able to support interviews with specialists in the high-demand specialties about what tests, imaging and preparations are needed before they see a patient. KCPA is now trial testing the resultant “Efficient Visit Guideline” with some safety net providers.

Identifying Credible Measures of the Problem

Uninsured: Projected Need for Specialty Care (2007)

Summary: MCPP consultants reviewed more than 20 different studies that looked at the demand for specialty care in populations of 100,000. These studies reflected a variety of delivery models in different locations as well as nationwide estimates of the physician workforce. 

Results:  MCPP projected that the uninsured patients at safety net clinics in King County will need more than 15,000 referrals for specialty care each year. More info...

Costs of Unnecessary Emergency Department Use by the Uninsured

How do we measure the cost savings from keeping patients out of an Emergency Department? The PHPDA commissioned a study of Emergency Department use in late 2008 to determine if there were quantifiable savings from caring for uninsured specialty care patients outside of hospital emergency departments.

Another study of emergency room visits had concluded that 1/3 of hospital emergency department visits could be provided in other settings, such as outpatient specialty or primary care clinics.

Although local data was limited, Phase 1 of the study identified a 40-60% decrease in the use of the emergency department use for communities with a “project access” model. Phase 2 of the study looked at year-end financial filing data for 13 King County hospitals in the Department of Health database. About 14,300 emergency room visits by low-income, uninsured persons in King County result in close to $20 million in Emergency Department charges. About 70% (on average) of uninsured patients treated in area hospitals are admitted through the Emergency Department. More info...