In an effort to reduce rising rates of ED use and inpatient hospitalizations, Dallas-based Baylor Scott & White was able to deploy a population health strategy, centered around the integration of social determinants of health data, to help accomplish the goal.
The initiative was studied and written about retrospectively in the April issue of Health Affairs. Baylor Scott & White Health leaders set out to reduce rising rates of emergency department use and inpatient hospitalizations in an underserved Dallas community that is home to many people with low socioeconomic status. The organization partnered with the Dallas Park and Recreation Department to create a level-three primary care clinic integrating wellness and prevention programs in a city recreational center. The goal of this private-public partnership, known as the Baylor Scott & White Health and Wellness Center (BSW HWC) was to implement wellness and other upstream strategies to address social determinants of health as well as patients’ access to routine primary care regardless of their ability to pay.
More specifically, the BSW HWC consists of a primary care clinic; Dallas recreational facilities; a research and development team; and several programs and services that address wellness, prevention, and social determinants of health integrated into healthcare delivery. The BSW HWC is built on the following four fundamental principles, according to the report’s authors, who are all affiliated with Baylor Scott & White Health: collaborative financial support and governance; the integration of social, cultural, political, and economic initiatives; provision of clinical care in the neighborhood; and community-based, interdisciplinary research.
Emergency department and inpatient care use was examined over 12 months after initiation of services at the center. People who used the center’s services showed a reduction in ED use of approximately 21 percent and a reduction in inpatient care use of 37 percent, with an average cost decrease of 35 percent and 54 percent, respectively.
The authors of the Health Affairs report noted that approximately half of all inpatient hospital admissions, which collectively had estimated costs in 2013 of $697 billion, begin in the ED. What’s more, although statistics vary by population, ED usage is generally higher among people from lower socioeconomic status communities, large metropolitan areas, and rural areas than in suburban or higher-socioeconomic-status areas.
For the study, individuals were included in the retrospective analysis if they had at least two visits to the BSW HWC in a given year in the period 2010 to 2015 and at least one ED visit or inpatient hospitalization in the year before or after a BSW HWC visit. To analyze the effect of BSW HWC programs and services, participants were retrospectively categorized into the following three mutually exclusive groups, depending on their frequencies of participation: the “health and wellness only” group, the “primary care clinic only” group, and the “health and wellness + primary care clinic” group.
In sum, the study sample consisted of 1,055 participants who used at least one ED or inpatient care service 12 months before or 12 months after initiation of care at the BSW HWC.
The results showed that the “primary care clinic only” group (those who used no wellness program services) showed a 44-percent reduction in ED use and a 46-percent reduction in inpatient care use. There was a cost per visit reduction of 47 percent and 55 percent, respectively.
Meanwhile, the “health and wellness only” group (those who used no primary care clinic services) exhibited a 6-percent increase in ED use and a 14-percent reduction in inpatient care use (neither significant, according to the report’s authors). This group had an increase of 20 percent in ED cost per visit and a decrease of 21 percent in inpatient care cost per visit.
And finally, the health and wellness + primary care clinic group showed a “nonsignificant” 17-percent reduction in ED use and a significant 36-percent reduction in inpatient care use. This represents cost reductions of 17 percent and 54 percent, respectively.
And to be sure that the decrease in use was not due to a large number of low utilizers before and after starting to use BSW HWC services, the researchers isolated participants with greater use of hospital services in the year before initiation of BSW HWC services.
Indeed, as the report’s authors stated, “The data show that providing access to a primary care clinic that also used strategies to improve social determinants of health was associated with significantly reduced ED and inpatient care visits and the corresponding costs. Additionally, providing access to wellness programs in combination with primary care was associated with fewer inpatient care visits and lower costs. These reductions in use and cost were particularly evident in people who had higher ED and inpatient care use before they began receiving BSW HWC services.”
The additionally concluded, “A population health approach that provided access to healthcare for people regardless of their insurance status and addressed social determinants of health was associated with a reduction in ED and inpatient care use and the associated cost. Evidence from this study supports the value of population health approaches that reach beyond the traditional health care system to provide healthcare that yields benefits for both the health system and the people and communities it serves.”