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Access to Specialty Care Grows for Low-Income and Uninsured Patients through Pilot Project

A pilot project has increased access to specialty care among low-income and uninsured Travis County patients and trimmed a waiting list of referrals for musculoskeletal care.

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AUSTIN, Texas — A pilot project — in place for just three months — has increased access to specialty care among low-income and uninsured Travis County patients, trimmed a waiting list of referrals for musculoskeletal care, and initiated a new approach to diagnosing and treating severe bone and joint pain that’s designed around patients.

The pilot project is a collaboration of the Dell Medical School at The University of Texas at Austin, Seton Healthcare Family, Community Care Collaborative (a partnership between Seton and Central Health, the local health care district) and community physicians. It was created to help the community start devising a comprehensive response to problems that low-income and uninsured patients have had accessing high-quality specialty care. Wait times for appointments have sometimes exceeded a year, and the region’s rapidly aging population threatens to exacerbate the situation.

In response, Dell Med, Seton, the Community Care Collaborative and community physicians launched a pilot project in June to expand access to musculoskeletal care — covering issues such as hip and joint pain — through a series of steps:

  • Increasing the number of community providers and resources, in part through Dell Med faculty and personnel;
  • Instituting a new referral and triage process that emphasizes clinical experience and patients’ conditions, preferences and values;
  • Using a multidisciplinary team to treat related health issues and establishing telephone and email consultations with primary care physicians and nurses; and
  • Working directly with patients to optimize their health, reduce their pain and improve their function and quality of life.

As a result, the pilot has:

  • Reduced by more than 730 the number of referrals waiting for musculoskeletal care.
  • Enabled 267 patients to get appointments with musculoskeletal specialists.
  • Helped about 30 percent of newly referred patients — generally those with the most serious health conditions — to get a musculoskeletal specialist appointment in 30 days or less.
  • Helped increase access to effective treatment plans, including physical therapy and appropriate surgical services.

There are many aspects that need to be considered in obtaining great patient outcomes. Patient attitudes are one of these factors,” said Earl Kilbride, an Austin orthopedic surgeon who has worked extensively with low-income and uninsured patients. “Previously, with such a long wait list, patients came in already defeated. As the efficiencies increase, patient satisfaction and thus outcomes improve in a parallel fashion.

For hundreds of patients, the program has already made a big difference.

“When I first signed up for this, I thought they weren’t going to do anything for me. I had pain every day, and I had gotten used to it over the years,” said Austin resident David Warren, who was treated through the pilot program. “Since the surgery, I have no pain and I’m back to hiking two miles a day.”

Kevin Bozic, the medical school’s chair of surgery and perioperative care, added, “This is an incredibly exciting project for all of us who are passionate about transforming health and creating better outcomes for our patients.”

Clay Johnston, inaugural Dell Medical School dean, said the lessons from the pilot will cut across other areas of health and specialty care, especially as the medical school builds out clinical operations and more leaders and faculty members come on board.

“This is exactly the sort of community benefit and patient-centric value that the Dell Medical School was created to bring to Austin,” Johnston said. “This is just one project, and it’s only been in place for a season. But we hope it demonstrates the transformative difference we can catalyze to help Austin become a model healthy city.”

The pilot also demonstrates that innovation and transformation are vital to improving health and expanding access among vulnerable populations, said Mark Hernandez, chief medical officer for the Community Care Collaborative.

“There is a real need for access and improved referral management — simply adding providers isn’t enough,” Hernandez said. “Low-income and uninsured patients need access to the most appropriate provider in order to manage their care.”

“This pilot exemplifies the benefits Seton envisioned when investing in the Dell Medical School in partnership with the CCC,” said Michelle Robertson, president of the Seton Family of Hospitals. “It aligns the dedicated clinical care provided to the community with new and innovative models of care to produce real improvements for those we serve.”