Safety-Net Providers In Some US Communities Have Increasingly Embraced Coordinated Care Models

ArticleinHealth Affairs 31(8):1698-707 · August 2012with15 Reads
DOI: 10.1377/hlthaff.2011.1270 · Source: PubMed
Abstract
Safety-net organizations, which provide health services to uninsured and low-income people, increasingly are looking for ways to coordinate services among providers to improve access to and quality of care and to reduce costs. In this analysis, a part of the Community Tracking Study, we examined trends in safety-net coordination activities from 2000 to 2010 within twelve communities in the United States and found a notable increase in such activities. Six of the twelve communities had made formal efforts to link uninsured people to medical homes and coordinate care with specialists in 2010, compared to only two communities in 2000. We also identified key attributes of safety-net coordinated care systems, such as reliance on a medical home for meeting patients' primary care needs, and lingering challenges to safety-net integration, such as competition among hospitals and community health centers for Medicaid patients.
    • "The implications of our findings are that safety-net clinics disproportionately care for high-need non-Medicaid insured individuals. Notably, other studies have suggested that safety-net clinics may lack the resources [1,[39][40][41][42]to invest in coordinated, multidisciplinary care models that are needed to achieve high quality, equitable, and comprehensive care.[12,34,43,44] Our findings confirm that minority and low-income insured individuals with private insurance or Medicare are more likely to use safety-net providers, though it is unclear whether the reason for greater safety-net use is a matter of proximity, access, preference, affordability, loyalty, cultural concordance, or other considerations. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective: To describe the prevalence, characteristics, and predictors of safety-net use for primary care among non-Medicaid insured adults (i.e., those with private insurance or Medicare). Methods: Cross-sectional analysis using the 2006-2010 National Ambulatory Medical Care Surveys, annual probability samples of outpatient visits in the U.S. We estimated national prevalence of safety-net visits using weighted percentages to account for the complex survey design. We conducted bivariate and multivariate logistic regression analyses to examine characteristics associated with safety-net clinic use. Results: More than one-third (35.0%) of all primary care safety-net clinic visits were among adults with non-Medicaid primary insurance, representing 6,642,000 annual visits nationally. The strongest predictors of safety-net use among non-Medicaid insured adults were: being from a high-poverty neighborhood (AOR 9.53, 95% CI 4.65-19.53), being dually eligible for Medicare and Medicaid (AOR 2.13, 95% CI 1.38-3.30), and being black (AOR 1.97, 95% CI 1.06-3.66) or Hispanic (AOR 2.28, 95% CI 1.32-3.93). Compared to non-safety-net users, non-Medicaid insured adults who used safety-net clinics had a higher prevalence of diabetes (23.5% vs. 15.0%, p<0.001), hypertension (49.4% vs. 36.0%, p<0.001), multimorbidity (≥2 chronic conditions; 53.5% vs. 40.9%, p<0.001) and polypharmacy (≥4 medications; 48.8% vs. 34.0%, p<0.001). Nearly one-third (28.9%) of Medicare beneficiaries in the safety-net were dual eligibles, compared to only 6.8% of Medicare beneficiaries in non-safety-net clinics (p<0.001). Conclusions: Safety net clinics are important primary care delivery sites for non-Medicaid insured minority and low-income populations with a high burden of chronic illness. The critical role of safety-net clinics in care delivery is likely to persist despite expanded insurance coverage under the Affordable Care Act.
    Full-text · Article · Mar 2016
    • "Many safety net hospitals are based on coordinated care programs which involve care coordination within a single provider or system. For example, patient's visits between their primary care provider and specialists are coordinated within the same hospital system [12]. Studies have also shown that, despite caring for vulnerable and finically disadvantaged populations, safety net institutions can still achieve equal or better outcomes than non-safety net hospitals [13]. "
    [Show abstract] [Hide abstract] ABSTRACT: Objective . To examine the impact of patient demographics on mortality in breast cancer patients receiving care at a safety net academic medical center. Patients and Methods . 1128 patients were diagnosed with breast cancer at our institution between August 2004 and October 2011. Patient demographics were determined as follows: race/ethnicity, primary language, insurance type, age at diagnosis, marital status, income (determined by zip code), and AJCC tumor stage. Multivariate logistic regression analysis was performed to identify factors related to mortality at the end of follow-up in March 2012. Results . There was no significant difference in mortality by race/ethnicity, primary language, insurance type, or income in the multivariate adjusted model. An increased mortality was observed in patients who were single (OR = 2.36, CI = 1.28–4.37, p = 0.006 ), age > 70 years (OR = 3.88, CI = 1.13–11.48, p = 0.014 ), and AJCC stage IV (OR = 171.81, CI = 59.99–492.06, p < 0.0001 ). Conclusions . In this retrospective study, breast cancer patients who were single, presented at a later stage, or were older had increased incidence of mortality. Unlike other large-scale studies, non-White race, non-English primary language, low income, or Medicaid insurance did not result in worse outcomes.
    Full-text · Article · Nov 2015
    • "Coordinated care involves centralised intake points, facilitated entry, defined clinical pathways and monitoring of health service use (Cunningham et al. 2012). It engages multiple providers and demands shared information systems. "
    [Show abstract] [Hide abstract] ABSTRACT: Australian Primary Health Networks could pioneer local health service reform for children and young people living in out-of-home care. Significant maltreatment, the leading cause of placement of 0-17-year-olds under the protective canopy of foster, kinship and residential care (described collectively as out-of-home care) left more than 50000 children vulnerable to poor health outcomes in 2013-14. Opportunistic health care is inadequate to meet the chronic and complex health needs of maltreated children. This article reviews some critical lessons from English commissioning and US healthcare marketplace reforms in an attempt to better meet the needs of children and young people in out-of-home care. It identifies key questions that Australian Primary Health Networks would need to resolve if they were to follow overseas trends and adopt health service commissioning as a means to provide more effective and efficient health care for this at-risk population.
    Article · Oct 2015
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