Community-Based Proactive Primary Care Reduces Emergency Health Care Use for Adults Without Insurance

BACKGROUND: Many Americans are in a coverage gap and unable to obtain affordable health insurance-particularly in non-Medicaid expanded states-which is associated with less preventative care, worse health outcomes, and a reliance on emergency care. OBJECTIVE: To evaluate whether navigating uninsured patients to community-based primary care clinics that provide integrated care reduces preventable emergency visits and associated costs. RESEARCH DESIGN: This retrospective study evaluated the volume and costs of emergency department and inpatient hospitalization for patients accessing community-based integrated primary care (BCC) located near hospital centers as compared with those receiving usual care (non-BCC). SUBJECTS: The BCC group included 16,069 patients, and a propensity score-matched control group included 16,069 non-BCC patients. Patients less than 18 years old, with documented mental health issues, or whose EHR data were incomplete were excluded from the study. MEASURES: Emergency department (ED) and inpatient hospitalization (IP) visits and direct costs. RESULTS: Overall, the average per-person-year direct IP costs of BCC patients was 48% lower ( P <.001) and direct ED costs 43% lower ( P <.0001) than non-BCC patients. BCC patients had ∼44% fewer IP visits, and 29% fewer ED visits compared with non-BCC at 1-2 years of follow-up. BCC patients with diabetes related complications had 28% less IP costs and 27% less ED costs compared with non-BCC patients over 4 years ( P =.03, P =.01, respectively). CONCLUSIONS: This study supports the strategic navigation of uninsured patients from emergency departments and community settings to community-based primary care clinics offering integrated services, highlighting a promising population health approach.