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Publication Date

10-29-2018

Keywords

patient characteristics, uninsured, primary care, poverty, specialty care

Abstract

Background: The Specialty Access for Uninsured Program (SAUP) is a Milwaukee County health system collaborative in which safety-net primary care clinics are paired with hospital/health systems. The clinics provide primary care services, while the hospitals provide a network of specialists. All specialty services are “covered” under SAUP at no cost.

Purpose: To examine the clinical, geodemographic, and referral pattern features of our SAUP patients and their journey to specialized care.

Methods: We prospectively identified and retrospectively reviewed patients ≥ 18 years of age residing in Milwaukee County that were enrolled in SAUP during 2017. To be eligible for SAUP (ie, managed care) patients must be established patients of Aurora Walker’s Point Community Clinic (Milwaukee, WI), 200% at or below the Federal Poverty Level, and unable to secure public or private insurance. Several variables of interest were retrospectively collected after initial SAUP enrollment. Descriptive statistics were used to describe the overall characteristics of our 2017 SAUP cohort. Regression was used to explore predictors of time from referral to specialty visit.

Results: Of the 99 patients enrolled in SAUP, 52.5% were female. The patient population had a mean age 46.5 years and body mass index of 30.9 kg/m2. Patients were predominately Hispanic (98.0%), Spanish-speaking (93.9%), had contact with primary care prior to enrollment (84.4%), and resided in 2 ZIP codes within Milwaukee County (85.9%). At the time of SAUP enrollment, patients primarily had a clinical history of hypertension (21.2%) and diabetes (23.2%). Overall, SAUP-enrolled patients were generally well, with 76.5% of patients having a modified Charlson comorbidity index score of zero. Of the patients enrolled in SAUP, 90.9% followed through with the specialty visit to date. Top specialty services to which patients were referred included obstetrics (13.1%), colonoscopy/colorectal surgery (12.1%), and ophthalmology (11.1%). The mean time between enrollment and specialty service visit was 30.1 days (median: 24.5 days), and no predictive variables were identified. Following the specialty services visit, 42.2% had contact with a primary care provider to date.

Conclusion: Patients in a managed-care specialty access program coordinated through our Milwaukee free clinics are relatively young and healthy, with follow-through percentages and wait times for specialty care at or better than national averages. Further research, including cost outcomes, is warranted.

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