In 2009, 48% of emergency room (ED) visits in Milwaukee County were classified as non-emergencies. Medicaid and uninsured patients accounted for 67% of those visits. Reducing avoidable emergency room (ED) visits and linking patients to medical homes is a key initiative of the Milwaukee Health Care Partnership. Under the auspices of the Emergency Department Care Coordination (EDCC) Committee, an initiative has been underway since 2007 to identify emergency department patients without primary care physicians and connect them to a Federally Qualified Health Center (FQHC) for ongoing care. By linking patients to medical homes and decreasing duplicative emergency room tests and procedures, this initiative is working to improve the quality, coordination and cost-effectiveness of care for Milwaukee’s vulnerable population.
The EDCC committee is comprised of hospital and FQHC physicians and case managers as well as representatives from the Wisconsin Health Information Exchange (WHIE), the Medicaid managed care organizations, the state Medicaid office and Milwaukee County based health departments. Using a combination of care coordination and health information technology, the EDCC committee has created an ED to Medical Home process for Medicaid and uninsured patients, with a particular focus on improving health outcomes for pregnant women and patients with asthma, COPD, diabetes and hypertension.
Since launching the ED Linking project in 2008 with four hospital EDs, the program has grown to include all 10 EDs and FQHCs in Milwaukee County, resulting in over 700 appointments each month with area safety-net clinics. The committee regularly updates its progress in a quarterly report.
The EDCC committee has established a community-wide ED to Medical Home referral protocol supported by MyHealthDIRECT web-based appointment scheduling.
Through health system and grant funding, intake coordinators in safety net clinics have been added to follow up with patient appointments scheduled in the ED and help establish those patients for ongoing primary care. The health systems have also enhanced the role of ED cast managers in transition care management for this patient population.
The Partnership has supported the implementation and continuous improvement of the WHIE, allowing for expanded functionality and content, aiding providers in clinical decision making and care planning.