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APHA Scientific Session and Event Listing

[ Recorded presentation ] Recorded presentation

A Boston teaching hospital's response to a state policy change restricting location of primary care for uninsured patients

Kim M. Simonian, MPH1, Katherine Flaherty, ScD1, and Kristen Mason, MA2. (1) Community Benefit Programs, Partners HealthCare, 1135 Tremont St, Suite 980, Boston, MA 02120, 6175852828, ksimonian@partners.org, (2) Community Benefits, Partners HealthCare, Renaissance Park, Suite 980, 1135 Tremont St, Boston, MA 02120

The Commonwealth of Massachusetts provides reimbursement for care provided to uninsured patients through its Uncompensated Care Pool (UCP). Although not a health plan, the UCP provides some coverage for uninsured patients at hospitals and health centers. Effective January 2005, the state instituted a policy restricting hospitals from seeking UCP reimbursement for primary care provided at hospital campuses. The intent of the policy was to direct patients toward less expensive community health center settings.

In order to better understand the 2,300 uninsured patients who used its hospital for primary care, Brigham and Women's Hospital conducted an analysis of patient utilization; focus groups with patients; and surveys with primary care physicians. Findings suggested that many existing primary care patients relied on the hospital for access to prescription medications; had been steered toward primary care at the hospital because they were uninsured; carried negative perceptions of care at community health centers; and were unsure about their options as uninsured patients.

These data suggested that uninsured patients needed more information about how and where they could access care as uninsured patients. The hospital decided to concentrate on redirecting uninsured patients presenting at the hospital who were not yet engaged in primary care there. With grant funding, the hospital hired an access coordinator to assist uninsured patients without a primary care site to engage in care at a community site.

In her first four months, this coordinator received 242 patient referrals and helped 165 patients secure primary care appointments.

Learning Objectives:

Keywords: Primary Care, Community Health Centers

Presenting author's disclosure statement:

Any relevant financial relationships? No

[ Recorded presentation ] Recorded presentation

Providing Insurance and Removing Barriers to Health Care for the Uninsured

The 134th Annual Meeting & Exposition (November 4-8, 2006) of APHA