In 2008, the Partnership commissioned a comprehensive MHCP Primary Care Access Study to serve as the foundation for a long range plan to address the need for access to primary health care services. The study found that while the county had an adequate supply of primary care providers based on physician to population ratios, profound shortages existed in the neighborhoods with the greatest medical need. Zip codes with the highest levels of poverty had 45% of the population, including 71% of the vulnerable population – but only 27% of the primary care physicians. This imbalance frames the ‘gap in access.’ Nationally, the gap in primary care access is approximately 20% for all populations and 30% for vulnerable populations. In Milwaukee County, the gap was significantly greater – 54% for vulnerable populations – underscoring the need for strategies to address unmet healthcare needs.
People without access to primary care are more apt to use emergency department services when they need care. For a twelve month period between 2006 and 2007, the Partnership study identified that about 47% of all emergency visits (170,142 visits) were avoidable, and could have been addressed in a primary care medical home. Approximately 100,000 of these so called “primary care treatable” visits were made by low income Medicaid and uninsured individuals.
The Primary Care Access Study showed that ten Milwaukee zip codes with the highest rate of poverty generated 60% of the avoidable emergency department visits. Not surprisingly, those ten zip codes have the lowest concentration of primary care providers in the community.
Emergency department care is more than five times as costly as primary care. On average an emergency department visit costs $800 per visit, excluding physician fees. A comprehensive visit to a primary care doctor in a Federally Qualified Healthcare Center (FQHC) is approximately a quarter of the cost. A rough estimate of the avoidable emergency department expense in 2007-2008 for low-income patients was an astounding $80,000,000. This additional and unnecessary expense is borne by all healthcare users through higher costs by patients, payers, and employers.
In response to the Primary Care Access Study, Milwaukee’s four FQHCs have expanded their capacity, recruiting 20 new providers and supporting a 13% increase in utilization by patients who are uninsured or covered by safety net programs.
Under the leadership of the Wisconsin Primary Health Care Association, partnership members actively supported the successful effort to secure the approval of the Governor and the state legislature for funding increases for community health centers, resulting in $1.3 million in additional support for Milwaukee FQHCs in 2009. In addition to the over $7 million in health system and private funding for FQHC medical homes for the uninsured, the Partnership continues to pursue State and Federal grants for FQHC capacity building.
In 2009, the Partnership commissioned the Planning Council to conduct an inventory of 45+ safety-net clinics in Milwaukee County and has supported IMPACT 211 to use the inventory for improved referrals for consumers, advocates and community health workers seeking medical, dental and behavioral health information and services.