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

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.

To evaluate whether navigating uninsured patients to community-based primary care clinics that provide integrated care reduces preventable emergency visits and associated costs.

This retrospective study evaluated the volume and costs of emergency department (ED) 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).

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 electronic health record data were incomplete were excluded from the study.

ED and inpatient hospitalization (IP) visits and direct costs.

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).

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.