Emphasizing access

With the average cost of an emergency room visit hovering at $1,200, funneling patients through the ER is not an effective way to manage chronic health conditions. Those who lack medical insurance aren't the only subgroup using the ER as a doctor's office.

Many folks across the country, insured, uninsured and underinsured, are forced to rely on emergency departments because they lack convenient access to physicians with specialized expertise.

Persistent health problems such as asthma, diabetes and hypertension are just a few of the conditions that require periodic checkups with medical specialists. Unfortunately, in some neighborhoods, specialists are in short supply. This is especially hard on the elderly, on people who lack access to reliable transportation, and on many others who don't have the luxury of requesting sick leave in order to travel long distances.

To tackle this problem in our nation's capital, Unity Health Care, a federally qualified community health center that is the leading source for primary care in Washington's at-risk areas, and Providence, a 289-bed D.C. hospital and member of Ascension Health, the nation's largest Catholic not-for-profit health system, have teamed up to expand access to convenient, affordable, high-quality medical care for all residents of the district, with special concern for the poor and vulnerable. The partnership specifically aims to increase points of contact with specialists, integrate electronic medical records for improved care coordination, build models focused on preventive care and reduce costs for both payers and providers by lessening duplicative testing.

As we lead the path toward clinical integration, the new alliance could come to serve as a model for other safety net hospitals and federally qualified health centers across the country.

Access is the most important pillar of the program. As a result of the partnership, physician specialists from Providence will now be available at Unity's primary-care health centers throughout the district. Existing primary-care services such as internal medicine, pediatrics and family medicine will remain in place, and residents will also be able to schedule visits with cardiologists, endocrinologists, gastroenterologists, general surgeons, oncologists and experts in at least 10 other subspecialties. The program ensures that all city residents, especially the most vulnerable, have access to primary and specialty care in their medical home.

In a continuously evolving healthcare environment, strategic partnerships have the potential to greatly improve the quality, coordination and cost-effectiveness of patient services. Another component of our partnership that other organizations can replicate is our embrace of clinical integration. Building upon the goals of the Affordable Care Act, we're striving to reduce costly, duplicative medical testing through the sharing of electronic health records—which has been estimated to save more than $81 billion annually nationwide. Embracing health IT can allow medical providers from partnering organizations to access one integrated medical record for each patient, thus lowering the financial burden and improving patient care.

Adopting a value-based care model is another sensible prescription for those seeking to reduce the number of trips to the ER and improve management of chronic diseases. For example, Unity and Providence have used innovative joint education programs for patients, medical staff and the general public as a way to promote healthy lifestyle choices.

Case in point, as an affiliate of the Joslin Diabetes Center based at Harvard Medical School, Providence has access to the best practice standards for diabetes care and certification of physicians as diabetes primary-care specialists. Unity providers and patients will now have access to this model, which will enhance diabetes education and standardize best practices. Providence is a Joslin partner in a CMS innovation grant, designed to demonstrate a reimbursement model for community-based diabetes education. This approach can be customized by any combination of hospitals and healthcare not-for-profits as a low-cost, high-impact tool to promote community health.

From an administrative standpoint, these partnerships have extensive cost-saving benefits involving informatics, patient eligibility, provider credentialing and provider coding services/education.

Historically, access to specialty care for many patients has been fragmented as a result of delayed appointments from limited access and a lack of coordination, leading to costly hospital visits. As healthcare professionals, we must all continuously strive to improve public health by keeping the residents of our communities healthy and out of the emergency room. We're proud to say our partnership will work to do just that, and we encourage our peers to join us in implementing this innovative healthcare-delivery model.