Finding a 'Medical Home'

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Three North Carolina systems join forces to ease the uninsured burden in the ED.

Can a computer database clear out several overcrowded emergency departments? Three health systems serving Wake County, NC, think it can--while improving patient care and giving each system a financial boost.

The three systems--WakeMed Health & Hospitals, Rex Healthcare and Duke Raleigh Hospital--are working with the Wake County Medical Society and the county's safety-net clinics to improve the way healthcare is provided to uninsured and underinsured residents. The CapitalCare Collaborative, currently completing its pilot phase, will help those patients establish a "medical home" that improves the continuity of their care while reducing the cost of providing it.

"This is a perfect project for us," says Jill Frye, director of patient access for 433-acute-care-bed Rex Healthcare, part of the UNC Health Care system. "It actually helps us with our financial improvement goals while improving quality of care and ease of access."

CapitalCare's first initiative: implementing a Web-based screening tool that helps determine if uninsured patients qualify for reimbursement or charity programs. The results are filed in the system so all providers know, for example, if the patient was recently enrolled in Medicaid or referred to a no-cost clinic.

"This will involve a lot of education to show people how to use the healthcare system efficiently," says Susan Weaver, MD, president of CapitalCare and executive director of Alliance Medical Ministry, a safety-net clinic and founding member of the collaborative.

Also on staff at two-hospital WakeMed, Weaver knows firsthand the benefits of moving patients into a primary-care home. Surveys show that once patients establish care at Alliance, 90 percent never return to an emergency department for non-urgent care. The average cost of a visit to Alliance is $80; the average cost at a hospital ED is $1,100.

Next up: Screening for low-cost or free pharmaceutical programs so CapitalCare members can help their uninsured and underinsured patients comply with medication orders. And in 2008, the database will be used to collect the patients' medical history, medications, laboratory and other data that CapitalCare members will share through a program compliant with the Health Insurance Portability and Accountability Act of 1996. Local foundations teamed with the providers to finance the collaborative's first year. Then two other funders jumped aboard, eager to participate in a program they believe can be replicated in other locales. They will fully fund the program through its third year. "Part of our funding is to work closely with them on replication of this model," Weaver says.

-Lola Butcher

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