Nearly two years ago Jay Mason called me telling me about his plan to create an appointment system whereby hospitals in Wisconsin could re-route their Medicaid patients to community and safety-net clinics. He told me that not only would it relieve ED overcrowding but that it would also allow providers to more efficiently deliver pro-bono care. I didn’t exactly rate highly his chances of success in creating a calendar referral system for Medicaid and uninsured patients, but I suggested that he check in with me when it was up and running. Here’s Jay on what My Health Direct is doing now, and it indeed sounds encouraging. Matthew Holt

By Jay Mason

The problems of emergency department overcrowding and increased bad debt affect nearly every urban acute care hospital in the country. Patients who seek care at an ED are four times more likely to be covered under Medicaid or twice as likely to be uninsured than their privately insured counterparts. 

In 2006, several hospitals sought a new approach to address some of their most entrenched challenges – overcrowded emergency departments, increasing levels of uncompensated care, and an ongoing imperative to maximize use of its clinical resources. They soon gravitated to a web-based solution called My Health Direct, which was created by start-up Global Health Direct for use in settings with a highly disproportionate share of the Medicaid and uninsured population.

Prior to adoption of My Health Direct, these EDs had no effective means of connecting patients with a primary care medical home. Referrals to clinics from EDs were infrequent and impractical, with fewer than 10% of patients referred actually resulting in a scheduled appointment. This had a direct impact on emergency room overcrowding and uncompensated care. 

After these hospitals deployed My Health Direct, all of that changed.  “My Health Direct allows us to provide any discharged patient with a confirmed primary care appointment,” said one ED medical director. “We find appointments with clinics that are timely, speak their language, and, if necessary, are located along public transportation routes.” 

My Health Direct also began extending out to areas of the hospital beyond their ED.  Inpatient discharge planning emerged as another valuable use of My Health Direct.  Hospitalists began using the tool to help patients find appropriate continuity of care, reducing inpatient lengths of stay. Additionally, a birthing center began using it to arrange for postnatal follow up care for newborns with Medicaid coverage. 

The independent and community-based clinics that participate in My Health Direct maintain total control over every aspect of how they receive appointments. They control the payer types, insurance plans, services offered, and which portions of their calendars to make available. The clinics make their appointments available on a recurring basis, minimizing the administrative updates required. 

The outcomes and impact that My Health Direct has made has been dramatic. More than 12,000 health appointments have been made with the vast majority of these appointments for patients who are uninsured or enrolled in a Medicaid managed care plan. These appointments were made for patients who either presented for care with a non-emergent condition, or needed follow-up care in a primary care setting. 

A utilization review of My Health Directs impact demonstrated that more than 92% of patients who received an appointment did not present to the ED again. Patients who obtained appointments were more than 4 times more likely to actually attend their appointment compared to previous referral efforts from the ED. Lastly, there was a 25% reduction in repeat non-emergent visits of those patients assisted by My Health Direct.

My Health Direct clients believe that it has played a key role in helping to address its challenges of overcrowded emergency rooms and uncompensated care.  A leading emergency department physician states, “Much of our ED overcrowding and uncompensated care comes from Medicaid and uninsured patients using the ED for walk-in care because they encounter barriers to primary care access.  My Health Direct gives us the tool to help these patients overcome these barriers and connect them with the primary care they sought in the first place.  Use of My Health Direct lets us help patients in a way that reduces overcrowding and uncompensated care. It is changing the culture.”

Both clinical and non-clinical staff enjoy using My Health Direct because it is quick and simple. “The tool is easy to use, and I can confirm an appointment for the patient in just a few minutes,” explained an Interim Manager of the Emergency Department at a large urban acute care hospital. “Prior to My Health Direct, our only options were calling clinics to try and find open appointments, or simply giving the patient the name and telephone number of a clinic. There is comfort in knowing that our patients will walk away with a confirmed appointment allowing for compliance and follow up care. Ultimately this will lead to better health."

The National Association of Community Health Centers estimates that there are over $18.4 billion billion in unnecessary ED visits a year. Collaborating with the community stakeholders made up of urban acute care hospitals and independent and community clinics, My Health Direct intends on seeing those dollars freed up to improve efficiency of resources and improvements in continuity of care.