Managed care for uninsured patients at an academic health center

A case study

Arthur Kaufman, Daniel J Derksen, Stephen McKernan, Pamela Galbraith, Saverio Sava, John Wills, Elizabeth Fingado

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

In 1997, the University of New Mexico Health Sciences Center ('the Center') created a managed care plan ('the Plan') for its uninsured patients who were county residents. The Plan's features include pooling the resources of existing county safety-net providers, enrolling patients with primary care providers at easily accessible neighborhood-based clinics, and investing in social support services, case management, and 24-hour telephone triage. After two years of the Plan's operation, the utilization of ambulatory care services by Plan enrollees, the number of discharges per 1,000 enrollees from the Center-affiliated University Hospital, and the number of hospital days per 1,000 enrollees had all dropped significantly (p < .001 for all). For the 13,114 enrollees in the Plan, University Hospital saved an estimated $1,904,872 per year in costs. The replacement of unpaid hospital days with paying patients is estimated to have yielded over $695,000 in additional revenues per year. The authors conclude that managing the care of uninsured patients in an academic health center can reduce ambulatory care and inpatient utilization and reduce the cost of care. To achieve these favorable outcomes requires the organization of services to meet the unique needs of the uninsured and underserved population.

Original languageEnglish (US)
Pages (from-to)323-330
Number of pages8
JournalAcademic Medicine
Volume75
Issue number4
StatePublished - Apr 2000
Externally publishedYes

Fingerprint

Managed Care Programs
managed care
Ambulatory Care
Health
Safety-net Providers
health
Costs and Cost Analysis
Triage
Case Management
Vulnerable Populations
Social Work
Telephone
Social Support
Inpatients
Primary Health Care
Patient Care
utilization
case management
health science
costs

ASJC Scopus subject areas

  • Nursing(all)
  • Public Health, Environmental and Occupational Health
  • Education

Cite this

Kaufman, A., Derksen, D. J., McKernan, S., Galbraith, P., Sava, S., Wills, J., & Fingado, E. (2000). Managed care for uninsured patients at an academic health center: A case study. Academic Medicine, 75(4), 323-330.

Managed care for uninsured patients at an academic health center : A case study. / Kaufman, Arthur; Derksen, Daniel J; McKernan, Stephen; Galbraith, Pamela; Sava, Saverio; Wills, John; Fingado, Elizabeth.

In: Academic Medicine, Vol. 75, No. 4, 04.2000, p. 323-330.

Research output: Contribution to journalArticle

Kaufman, A, Derksen, DJ, McKernan, S, Galbraith, P, Sava, S, Wills, J & Fingado, E 2000, 'Managed care for uninsured patients at an academic health center: A case study', Academic Medicine, vol. 75, no. 4, pp. 323-330.
Kaufman A, Derksen DJ, McKernan S, Galbraith P, Sava S, Wills J et al. Managed care for uninsured patients at an academic health center: A case study. Academic Medicine. 2000 Apr;75(4):323-330.
Kaufman, Arthur ; Derksen, Daniel J ; McKernan, Stephen ; Galbraith, Pamela ; Sava, Saverio ; Wills, John ; Fingado, Elizabeth. / Managed care for uninsured patients at an academic health center : A case study. In: Academic Medicine. 2000 ; Vol. 75, No. 4. pp. 323-330.
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