Concierge-Level Care for Underserved Communities: Not a Pipe Dream.

Abstract

St. Thomas (STCHC) has a long history of serving an urban, uninsured, and underinsured (Medicaid) population in the greater New Orleans area. Beginning in 2010, STCHC faced financial danger when Louisiana did not expand Medicaid coverage. Partnering with the nonprofit Institute for Healthcare Optimization (IHO), we increased patient throughput by balancing the clinic's resources between two modalities of care: urgent (same/next day) appointments in which patients were seen by whichever provider was available; and less urgent, in which patients saw their preferred PCP at the provider's availability. Assessing patient's appointment preferences was crucial in directing this innovation. We analyzed 8913 appointments and patients' priorities between being cared for by a preferred provider or being seen on the same/next day. Appointment outcomes (i.e., occurred, no-show, canceled, or rescheduled) were matched to each preference group and no-show rates were calculated. When 80% to 90% of same-day requests were satisfied, the proportion of no-shows declined significantly, and patients' satisfaction with access to care reached 97%. Clinic appointment kept rate became 87% (95% CI [0.869975, 0.870025]). Disseminating these results nationwide would result in many lives and millions of dollars saved. Large-scale educational and implementation efforts are needed.