Access to and utilization of quality health care greatly affects a person’s health. In particular, a usual and ongoing source of care leads to better health outcomes and fewer costs.1 However, in 2012, about 1 in 5 adults ages 18-64 did not have a usual source of care.2 In addition, patients benefit when their usual source of care is a primary care provider (PCP), as PCPs form relationships with their patients and increase the likelihood their patients will receive appropriate care.
When one of the major regional safety net hospitals in St. Louis, Missouri closed, key stakeholders and providers in the region came together under the umbrella of the St. Louis Regional Health Commission to address the lack of available services and to ensure that underserved populations would continue to have access to ongoing care. From their efforts, the St. Louis Integrated Health Network (IHN) was formed in 2003. The IHN is a regional network of safety-net providers that exists to:
- Integrate and coordinate services for its patients
- Link Medicaid and uninsured patients with a primary care home
- Reduce non-emergent emergency department use
The IHN has received support from federal agencies such as the Health Resources and Services Administration (HRSA) and the Centers for Medicare and Medicaid Services (CMS) to promote their work in the St. Louis area.
Over the past decade, the IHN has implemented several initiatives to support coordination of services and encourage patients to access primary care, including the Community Referral Coordinator (CRC) program. As part of the CRC, the IHN hires and places CRCs in hospital emergency departments to identify patients without a usual source of care. CRCs work with patients to schedule follow-up appointments at local community health centers and educate patients on the importance of effective primary care. Coordinators conduct outreach via mail and phone and use a web-based portal to track patients and improve show rates for follow-up appointments. Through this outreach, CRCs raise awareness of the accessible nature of local health centers, with their extended hours and sliding fee-scales. The CRC program offers a valued service to patients by easily making convenient appointments for them using their direct knowledge of and relationships with the community health centers.3
Since its inception as a pilot program in the emergency departments of two hospitals, the CRC program has expanded to eight hospital settings. Between 2008 and 2012, referrals to community health centers tripled. More importantly, the efforts of the CRC program have decreased the no-show rate at follow-up appointments from 75% in the first quarter of 2009 to just over 58% in the fourth quarter of 2013.4, 5 In 2013, the CRC program shifted its focus to target specific patient groups, including patients with an already established community health center and patients with a chronic illness who were being discharged from the inpatient unit. Community health centers, hospitals, and public health departments that partner with the IHN are demonstrating strong collaboration in the region to continue to provide health care services for underserved populations in the St. Louis region.
3NORC at the University of Chicago. Final Report: The Community Referral Coordinator Program, 2009-2011.
4NORC at the University of Chicago. Final Report: The Community Referral Coordinator Program, 2009-2011.
5St. Louis Integrated Health Network. Community Referral Coordinator Program Update: October 1, 2013-December 31, 2013. Accessed February 3, 2014.
Supplemental Material: For more information, read these figures from the St. Louis Integrated Health Network.