Service utilization by high-need, high-cost patients following emergency department visits

To compare the likelihood of timely outpatient follow-up care and repeat emergency department (ED) visits and hospitalization among patients with high need and high costs (HNHC) across 4 primary care provider (PCP) types.

Our cross-sectional study analyzed 2018 eligibility and claims data of patients with HNHC enrolled in California Medicaid managed care (N = 164,543).

Outcomes were outpatient follow-up visits for primary care, specialty care, mental health, or substance use disorder (SUD) within 7 days and ED readmission and all-cause hospitalization within 30 days of the first ED visit (index ED). Our independent variable was PCP type, categorized as Health Resources and Services Administration-funded health centers, group practices, solo practices, and other community clinics. Multivariable logistic regression models examined follow-up care utilization by PCP type.

One-third of index ED visits were followed by a primary care (30.3%) or specialty care (31.8%) visit within 7 days. Within 30 days of the ED index visit, approximately 22% had a repeat ED visit and 6% had a hospitalization. Health center patients were more likely to have a primary care, mental health, or SUD follow-up visit than patients of other PCPs and were less likely to have a follow-up specialty visit, ED readmission, or hospitalization.

Findings indicate that health centers have been successful in linking patients to outpatient services that may reduce costly hospitalizations and repeat ED visits but could improve on linkage to specialty care. Improved process-of-care approaches may reduce repeat ED visits and hospitalizations across all PCP types.