Medicaid-serving Health Maintenance Organization-Federally Qualified Health Center (HMO-FQHC)-School of Public Health Collaboration to Provide After-Hours Pediatric Urgent Care: A One Year Demonstration Project

Aim: To demonstrate the collaboration of Medicaid-serving Health Maintenance Organizations (HMOs) and Federally Qualified Health Centers (FQHCs) supported by the design and evaluation skills of a School of Public Health in providing pediatric after-hours urgent care in a large urban metropolitan area, and to study the implications of implementation of this collaborative effort in reducing the Emergency Department (ED) patient load.

Study Design: Prospective evaluation using pre-post comparison study design.

Methodology: Three FQHCs located in the Houston area were selected to participate in this demonstration project in collaboration with the city's three largest Medicaid-serving HMOs. The HMOs conducted a marketing campaign directed at members living in 24 zip codes in the intervention area for the availability of after-hours pediatric care at the three FQHCs. The University of Texas School of Public Health (UTSPH) supported the project team with design and evaluation expertise, obtained and analyzed enrollment, service use, and cost data from the HMOs for the project’s pre-intervention period, August 1, 2009 through July 31, 2010 and from the project’s post-intervention period, August 1, 2010 through July 31, 2011. The primary objective of the study was to determine if there were any differences in pre-post service use and cost patterns in the Medicaid and Children’s Health Insurance Program (CHIP) HMO enrollees in the Houston neighbourhoods targeted by the intervention compared to enrollees in non-targeted areas.

Results: The evaluation study found that the proportion of enrollees in the intervention group having an ED visit decreased from 17% to 12% whereas the proportion of enrollees in the comparison group stayed the same for ED visits (18%). The proportion of enrollees in the intervention group having a physician office visit decreased from 73% to 72% whereas the proportion of enrollees in the comparison group having a physician office visit decreased from 64% to 57%.

Conclusion: The evidence suggests that patterns of ED and physician office visits and costs of Medicaid/CHIP enrollees changed after the first year of implementation of an after-hours project. These results are encouraging for a strategy of working with community-based providers such as FQHCs in making clinic services available in evenings and on weekends, along with promoting the availability of those services, as a way of lowering rates of ED use and costs in the Medicaid/CHIP population in the Houston/Harris County area.