Express care and case management: A model to relieve the burden of hospital emergency departments providing primary care services

This demonstration project, funded by CMS, is designed to provide alternate non-emergency services to patients who use hospital emergency departments for primary care needs and encourage their future use of an appropriate and cost-effective care site. The program model involves partnership of a community hospital and a nearby FQHC (or other primary care provider) to make process changes necessary for a more efficient system addressing needs of culturally diverse communities. In this model, once an ED patient is identified with primary care needs following triage/screening per EMTALA, an advanced practice nurse provides express care services/prescriptions, and sets up the follow-up appointment with a primary care provider in the community, using a secure Web-based electronic information system. As part of discharge services for Medicaid/uninsured patients, the APN will identify patient barriers and educate them on importance of using appropriate site of care for primary care services, limiting ED visits to true emergency situations. Case managers will also monitor ED utilization, track compliance with follow-up visits, identify repeat ED users, and work with the partner FQHC to help patients resolve barriers, find a more accessible permanent medical home and get linked with intensive chronic disease management programs. The project is piloted in two sites, located in medically-underserved counties with high rate of ED use by Medicaid beneficiaries. The evaluation measures and anticipated outcomes include reduced hospital ED use for primary care services; reduced hospitalizations for chronic diseases complications or ACS conditions; increased capacity of primary healthcare system; and cost savings for Medicaid.