Unity Health Care's Convenient Care Initiative: Keeping D.C. Residents Out of the Emergency Room

Dr. Janelle Goetcheus, Founder, Chief Medical Officer and Executive Vice President of Medical Affairs of Unity Health Care | 8/7/2013, noon

Unity Health Care, Inc. (Unity) is a nonprofit community health care organization in D.C. that provides health and wellness for more than 100,000 city residents every year. Through our network of 29 health centers, a mobile medical unit and with the commitment of more than 1,000 dedicated staff members, Unity continues to care for those residents who are most in need, regardless of their ability to pay.

Unity’s Convenient Care Initiative

In July 2012 (thanks to the generous support of our partners CareFirst BlueCross BlueShield), Unity launched its “Convenient Care” initiative, increasing access to healthcare for those living in under-resourced communities by keeping our two largest health centers (Upper Cardozo and Minnesota Avenue) open seven days a week. This effort allows community members who are unable to access health services during regular business hours the opportunity to receive comprehensive primary, preventative and specialty care services 7 days a week.

Our goal through the “Convenient Care” initiative is to improve care coordination and health outcomes in the residents of our city by expanding access to evening and weekend hours among patients with chronic diseases who access emergency services 3 or more times in a 6-month period. In order to meet this goal, Unity’s strategy is to focus on (1) engaging an emergency room diversion team to provide vital community outreach; (2) operating within a best practices model to ensure patient care coordination, and (3) increasing accessibility to primary care services by providing the members of our communities with viable emergency room alternatives.

Why Do We Need Convenient Care?

Health care costs across the United States have spiraled out of control over the last 20 years with spending increasing more than 8 times since 1990. According to the Centers for Medicare and Medicaid Services (CMS), the U.S. is projected to spend over $2.5 trillion on health care in 2009 ($8,160 per patient). With the vast majority of expenditures arising from hospital care and clinical physician services it is important that we reevaluate the way care is provided across the country to find innovative ways to cut costs while continuing to improve both quality and access to care.

According to recent statistics, more than 50% of all emergency department visits are considered primary care sensitive (which means they are primary care treatable, preventable, and/or avoidable). In addition, approximately 30% of the emergency room visits for individuals who are 40 and older were emergent but were also treatable, preventable and/or avoidable. Our data also indicates that 50 - 75% of District residents covered by Medicaid or Alliance used the emergency room at least once last year and rates of inpatient hospitalizations for chronic conditions (such as heart disease, HIV/AIDS, asthma or diabetes) ranged from 23 – 34%. The patient profile is further defined when looking at emergency room utilization rates based on admission dates and times. Rand’s report also identified that emergency room admissions in the District typically occur between the hours of 9am and 8pm (with 30% of all admissions occurring on Saturday and Sundays between 9 and 8pm.)