Health Maintenance Organization-Federally Qualified Health Center (HMO-FQHC) Collaboration to Provide After-Hours Pediatric Primary Care: A Feasibility Study
Leah S. Fischer
The University of Texas Health Science Center- Houston, School of Public Health, P.O. Box 20186, Houston, Texas 77225, USA.
Charles E. Begley
The University of Texas Health Science Center- Houston, School of Public Health, P.O. Box 20186, Houston, Texas 77225, USA.
Shabnam Azadeh
The University of Texas Health Science Center- Houston, School of Public Health, P.O. Box 20186, Houston, Texas 77225, USA.
Xuan G. Tran
Texas Children’s Health Plan, P.O. Box: 301011, NB-8391, Houston, Texas 77230-1011, USA.
Angelo P. Giardino *
Texas Children’s Health Plan, P.O. Box: 301011, NB-8391, Houston, Texas 77230-1011, USA and Baylor College of Medicine, One Baylor Plaza, Houston, Texas 77030, USA.
*Author to whom correspondence should be addressed.
Abstract
Aims: Examine feasibility, implementation and impact of a Health Maintenance Organization (HMO)-Federally Qualified Health Center (FQHC) collaboration in providing after-hours care as an Emergency Department (ED) diversion strategy.
Study Design: Prospective study using pre-post comparison design.
Methodology: Service enhancement program with the addition of after-hours clinic services coupled with a Texas Children’s Health Plan outreach campaign were conducted in Houston, Texas to promote the increased availability of clinic services during a six month period from September 2006 to February 2007 to enrolled Medicaid and State Children’s Health Insurance Program (SCHIP) enrollees. Claims data were used to identify after-hours clinic utilization and a pre-post analysis compared ED use rates of after-hours clinic users, non-users within the service area, and other enrollees in the health plan. Start-up costs provided by community funders amounted to 46,000 dollars (onetime payment) and marketing outreach campaign was supported with 52,000 dollars from TCHP.
Results: During the intervention time frame, September 1, 2006 thru February 28, 2007, at least 194 enrollees visited the after-hours clinic. An impact on ED utilization was not found and the six-month post intervention ED utilization for both the intervention and comparison groups increased when compared to the six-month baseline measurement period.
Conclusion: Establishing and promoting the after-hours clinic during this project targeting HMO enrollees was determined to be feasible with at least 194 enrollees who resided in the targeted area visiting the after-hours clinic at the FQHC.A six-month study period was long enough to examine the feasibility of providing after-hours pediatric health services, but probably not long enough to assess the full impact of after-hours health services on ED use. Further study, over an entire year allowing for the incorporation of both high and low seasonal trends will be essential to definitively assess if and HMO-FQHC collaboration on an after-hours clinic is an effective strategy to reduce ED visits in a traditionally underserved population of children covered under the Medicaid and SCHIP.
Keywords: Emergency department (ED) diversion, pediatrics, medicaid, state children’s health insurance program (SCHIP), primary care, community health centers.