Title: The Access Partnership (TAP)
Organization: Johns Hopkins Medicine
Innovation type: Access Program
What They’re Doing: Access to outpatient primary and specialty care and patient navigation for uninsured, low- income individuals
Clinical Innovation: Connects uninsured or underinsured low-income East Baltimore residents with primary care physicians and specialists (radiologists, psychiatrists, ophthalmologist physical therapists, etc.) who are willing to provide care on a pro bono basis in an outpatient setting. (“Underinsured qualified patients” include those enrolled in Primary Adult Care, because the Primary Adult Care program does not provide coverage for outpatient specialty care.) Patients are referred for specialty care by their primary care physician at one of five Hopkins primary care clinics and referrals are reviewed for medical necessity and effectiveness by the TAP Medical Director, who confers with referring physicians when appropriate. If approved, the patients must show a personal commitment to receiving the specialty care by paying a $20 participation fee before the appointment is scheduled. Once this fee is paid, the TAP Navigator helps patients schedule their appointments, helps arrange transportation if needed, calls patients to remind them up upcoming appointments, and follows up with patients after their appointments to make sure things went smoothly.
Evaluation Type: Quasi-Experimental.
Evaluation Plan: Efforts are underway to examine patient access to primary care and specialty care, the impact of the program on physician and patient satisfaction, and the impact on patients' ED utilization and inpatient admissions. The long-term evaluation plans includes an analysis of patients health outcomes, overall health care costs, and changes in health care utilization compared to their health outcomes, costs, and utilization prior to participating in the program and compared to similar patients with medical assistance.
Patient Outcomes and/or cost outcomes: Evaluation currently ongoing. Patient and cost outcomes date will be available September, 2012.
Other results of interest:
An evaluation compared the no-show rate for patients enrolled in TAP compared to patients covered by Medicaid receiving care at the same clinic and also investigating the characteristics of the patients who are offered enrollment in TAP but who fail to follow through. Patient and physician satisfaction survey were conducted.
Reduced the no-show rate: The no-show rate in the TAP population was 8%, compared to an average of 40% in the Medicaid population for appointments at the same primary care clinic. For all specialty care referrals requested by the patients’ primary care clinicians, the referrals that patients were least likely to follow-through with were psychiatry (87), ophthalmology (74), and physical therapy (58). Patients were much more likely to attend diagnostic tests (such as radiology) and specialty exams.
Findings of a 10 minute telephone survey of 56 patients (76% response rate) conducted between March and April 2010, showed:
• 88% of patients reported that they were able to obtain needed health care after TAP versus 33% before TAP
• 92% of patients were satisfied with health care after TAP versus 25% before TAP
The response rate for referring clinician satisfaction surveys was 85%, with 11 clinicians responding.
One year after program implementation, 11 out of 13 clinicians from EBMC responded to a survey, which showed:
• 82% strongly agree or agree that TAP has helped them to be more thoughtful about appropriateness of referrals to specialists.
• All clinicians strongly agree or agree that TAP has improved their ability to serve uninsured/underinsured patients.
Target Population: Uninsured or underinsured patients with demonstrated financial need living in seven zip codes in East Baltimore, and a patient at one of five Johns Hopkins primary care clinics.
Date of Implementation: May 2009
Desiree de la Torre
Where to learn more: Desiree de la Torre