NYC Health + Hospitals piloted a care management program in six of its emergency departments, and while it led to more patients connecting to primary care, there's still room for improvement.
Mitchell Katz, M.D., NYC Health + Hospitals' new CEO, has said he'll make primary care a priority at the system, saying an increased focus on primary care access helped him eliminate a $270 million budget deficit as head of the Los Angeles County Health Agency.
The country's largest municipal health system launched the pilot in September 2014 under a grant from the Center for Medicare and Medicaid Innovation, with an eye toward decreasing unnecessary ER visits.
Over the course of three years, the system enrolled more than 94,000 emergency patients in the care management intervention, according to a NEJM Catalyst post.
NYC Health + Hospitals clinicians engaged with patients in the program face-to-face, conducted follow-up calls, connected them with community groups and offered care planning and medication management.
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When compared to a control group that did not receive the intervention, patients enrolled in the care management program were 15% more likely to visit a primary care provider, according to the post.
However, 90-day emergency room revisit rates only declined slightly, from 30% to 20%, and inpatient admission rates were about the same for both patient groups.
The care management program identified several opportunities to improve, according to the post. NYC Health + Hospitals staffers want to spend more time evaluating the relationship between primary care and inpatient care usage, and the diversity of the system's patient population highlights the need to work and engage more with community groups to address the social determinants of health.
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Increasing access to primary care is viewed as a key strategy to reduce emergency room overuse. Long wait times for primary care appointments can impede that access; one potential solution is for PCPs to offer extended hours on nights and weekends.
That said, research has called into question if many emergency department visits deemed unnecessary really are. A study published last summer examined more than 115,000 records and found just 3.3% of ER visits were avoidable.