Impact of a Student-Faculty Collaborative Primary Care Clinic on Emergency Department Utilization: Shifting the Discussion Towards Value-Based Healthcare

Abstract

Purpose: Student-run clinics (SRCs) provide primary care access to low-income patients who otherwise would pursue more expensive care such as visits to emergency departments (ED). Decreasing inappropriate ED utilization offers a major opportunity to create value in the health care system. To date, no SRC has rigorously studied this. We hypothesize that increased access to ambulatory care through the Crimson Care Collaborative (CCC), a student-run clinic, is associated with decreased ED utilization, providing value to both providers and payers justifying the investment in SRCs. Methods: A five-year retrospective analysis was conducted to determine if ED utilization changed after patients enrolled in CCC. Patient level ED visit data was used to estimate the average change in ED utilization. A regression analysis examined the impact of demographic and clinical variables on change in ED utilization. Results: Average per patient ED utilization significantly (p<0.01) decreased by 28%, 40%, and 48% for patients enrolling in CCC from 2013-2015, respectively. Regression analysis revealed that for each additional visit to the CCC clinic, ED utilization per patient decreased by 0.44. This decrease translates to 41 avoided ED visits annually, and estimated payer savings of $51,812, approximately 41% of the clinic’s operating budget. Conclusions: CCC created value to payers and the provider from 2013-2015 by providing an alternative source of care, and increasing capacity in the hospital ED for more acute emergent and appropriate care. This study suggests that SRCs can create financial value to society, and initiate a shift in the medical education conversation toward value-based care.