Smaida S, Calderon Torres W, Kram JJF, Ohly S, Baumgardner DJ. Specialty Access for the Uninsured Program: system costs before and after enrollment. Poster presented at: Aurora Scientific Day; May 22, 2019; Milwaukee, WI.
Poster presented at: Aurora Scientific Day; May 22, 2019; Milwaukee, WI.
Background: The Specialty Access for Uninsured Program (SAUP) is a partnership within Milwaukee County in which safety-net primary care clinics are paired with hospital/health systems for specialty care. Health systems are assigned a portion of the income-eligible uninsured patients in the county, who then receive specialty services at no cost
Purpose: To examine differences in cost, hospitalization, and use of emergency department (ED) and urgent care prior to and following SAUP enrollment.
Methods: We prospectively identified and retrospectively reviewed patients, age ≥18 years, residing in Milwaukee County who were enrolled in SAUP during 2017. Several variables were retrospectively collected prior to and following initial SAUP enrollment. Calendar-year cost data were identified per patient for the year prior to SAUP enrollment (2016), the year of SAUP enrollment (2017), and the year following SAUP enrollment (2018). Costs in 2016 and 2018 were adjusted to match 2017 costs. Paired t-tests were used to compare care (eg, number of hospital admits 12 months prior to and following SAUP enrollment) and cost-related differences. A P-value less than 0.05 was considered significant.
Results: Of the original 99 patients enrolled in SAUP, 13 were excluded for not following up with care. Previously reported patient characteristics remained similar. Only 67.4% of SAUP patients were established patients 12 months prior to SAUP enrollment; 73.3% were established patients 6 months prior to enrollment. Mean time between enrollment and specialty service visit was 30.8 days (median: 25.0 days), and 46.5% had contact with a primary care provider following specialty services. Mean number of hospital admissions (0.14 vs 0.15), ED admissions (0.36 vs 0.30), and urgent care visits (0.02 vs 0.00) 12 months prior to and following SAUP enrollment, respectively, were not statistically different. However, the mean number of no-show visits 12 months prior to and following SAUP enrollment declined significantly (0.89 vs 0.34, respectively; P=0.001). Mean charges significantly increased from 2016 to 2017 ($7048 vs $35,091, respectively; P=0.002) and from 2016 to 2018 ($7048 vs $14,552, respectively; P=0.034), but significantly decreased from 2017 to 2018 ($35,091 vs $14,552, respectively; P=0.013).
Conclusion: Charge increases during the years of specialty episode care are reflective of care delivered. A significant decline in the number of no-show visits indicates the possible development of a clinic relationship, often seen when patients establish trust in a medical home.