Investments that pay off: How comprehensive program evaluation can help a community collaborative provide timely and effective care for the uninsured

Communities nationwide are collaborating to address the fragmented healthcare system and help the uninsured. Evaluation of these collaboratives is essential, providing feedback on outcomes, recommending areas for improvement, and leveraging community and financial resources. Health Policy Research Northwest conducted an evaluation of Project Access NOW (PANOW), a collaborative located in the Portland, Oregon area. PANOW mostly coordinates specialty care and ancillary services, but primary care services are increasingly being offered. The evaluation incorporated quantitative and qualitative measures from several sources. Member demographics were collected at enrollment. Administrative data was analyzed to measure utilization, disease prevalence, and the financial value of services provided. Member surveys were administered telephonically at enrollment and exit from PANOW to measure satisfaction/experiences and impact on self-reported health and utilization. Data was collected from 03/2008-12/2009. Final results will be presented. An interim analysis conducted on data through 06/2009 showed 1,339 members generated 7,489 encounters and $3.9 million in donated services. Members were mostly female (54%), >=40 years (61%), English-speaking (64%), unemployed (66%), and racially/ethnically diverse: 42% Non-Hispanic White, 38% Hispanic, 7% American Indian/Alaska Native, 5% Non-Hispanic Black, and 8% Other. Member surveys revealed a significant drop in emergency department visits (p=0.01) and significant improvement in health status (p=0.0162) after a PANOW enrollment term. Common services provided to PANOW members were: evaluation/management (75%), laboratory studies (51%), other therapeutic procedures (36%), medications (25%), surgical or minimally invasive procedure (22%), and other diagnostic procedures (22%). The most common primary diagnosis was diabetes (6%). Diabetes was positively associated with the member going without medical care prior to enrollment (p=0.04), highlighting the importance of effective care coordination through PANOW. The proportion of members reporting mental health-related stressors (53%) or dental concerns (73%) at enrollment was much higher than that captured in the claims (8% and 0.1%, respectively). This is likely due to under-reporting of comorbid conditions and because PANOW services do not include mental or dental healthcare. It was recommended that PANOW broaden its network to include mental and dental healthcare professionals, if members are not accessing these services elsewhere in the community. This presentation will share final evaluation results, recommendations and their impact on PANOW's operations. As greater attention turns toward community collaboratives' roles in healthcare delivery's future, reliable evaluation methods are needed. Community collaboratives often operate on a shoe-string budget; however, a good program evaluation model can provide critical feedback to guide program development and impact care delivery.