TY - JOUR
AU - H. Kitzman
AU - A. Mamun
AU - N. Fleming
AU - K. Sykes
AU - J. Zsohar
A1 - 
AB - BACKGROUND: Many Americans are in a coverage gap and unable to obtain affordable health insurance-particularly in non-Medicaid expanded states-which is associated with less preventative care, worse health outcomes, and a reliance on emergency care. OBJECTIVE: To evaluate whether navigating uninsured patients to community-based primary care clinics that provide integrated care reduces preventable emergency visits and associated costs. RESEARCH DESIGN: This retrospective study evaluated the volume and costs of emergency department and inpatient hospitalization for patients accessing community-based integrated primary care (BCC) located near hospital centers as compared with those receiving usual care (non-BCC). SUBJECTS: The BCC group included 16,069 patients, and a propensity score-matched control group included 16,069 non-BCC patients. Patients less than 18 years old, with documented mental health issues, or whose EHR data were incomplete were excluded from the study. MEASURES: Emergency department (ED) and inpatient hospitalization (IP) visits and direct costs. RESULTS: Overall, the average per-person-year direct IP costs of BCC patients was 48% lower ( P <.001) and direct ED costs 43% lower ( P <.0001) than non-BCC patients. BCC patients had ∼44% fewer IP visits, and 29% fewer ED visits compared with non-BCC at 1-2 years of follow-up. BCC patients with diabetes related complications had 28% less IP costs and 27% less ED costs compared with non-BCC patients over 4 years ( P =.03, P =.01, respectively). CONCLUSIONS: This study supports the strategic navigation of uninsured patients from emergency departments and community settings to community-based primary care clinics offering integrated services, highlighting a promising population health approach.
AD - O'Donnell School of Public Health, UT Southwestern Medical Center, Parkland Health, Dallas, TX.; Baylor Scott and White Health, Dallas, TX.; Robbins Institute for Health Policy and Leadership, Baylor University, Waco, TX.
AN - 41914492
BT - Med Care
C5 - Healthcare Disparities
DA - Mar 31
DO - 10.1097/mlr.0000000000002311
DP - NLM
ET - 20260331
JF - Med Care
LA - eng
N2 - BACKGROUND: Many Americans are in a coverage gap and unable to obtain affordable health insurance-particularly in non-Medicaid expanded states-which is associated with less preventative care, worse health outcomes, and a reliance on emergency care. OBJECTIVE: To evaluate whether navigating uninsured patients to community-based primary care clinics that provide integrated care reduces preventable emergency visits and associated costs. RESEARCH DESIGN: This retrospective study evaluated the volume and costs of emergency department and inpatient hospitalization for patients accessing community-based integrated primary care (BCC) located near hospital centers as compared with those receiving usual care (non-BCC). SUBJECTS: The BCC group included 16,069 patients, and a propensity score-matched control group included 16,069 non-BCC patients. Patients less than 18 years old, with documented mental health issues, or whose EHR data were incomplete were excluded from the study. MEASURES: Emergency department (ED) and inpatient hospitalization (IP) visits and direct costs. RESULTS: Overall, the average per-person-year direct IP costs of BCC patients was 48% lower ( P <.001) and direct ED costs 43% lower ( P <.0001) than non-BCC patients. BCC patients had ∼44% fewer IP visits, and 29% fewer ED visits compared with non-BCC at 1-2 years of follow-up. BCC patients with diabetes related complications had 28% less IP costs and 27% less ED costs compared with non-BCC patients over 4 years ( P =.03, P =.01, respectively). CONCLUSIONS: This study supports the strategic navigation of uninsured patients from emergency departments and community settings to community-based primary care clinics offering integrated services, highlighting a promising population health approach.
PY - 2026
SN - 0025-7079
ST - Community-Based Proactive Primary Care Reduces Emergency Health Care Use for Adults Without Insurance
T1 - Community-Based Proactive Primary Care Reduces Emergency Health Care Use for Adults Without Insurance
T2 - Med Care
TI - Community-Based Proactive Primary Care Reduces Emergency Health Care Use for Adults Without Insurance
U1 - Healthcare Disparities
U3 - 10.1097/mlr.0000000000002311
VO - 0025-7079
Y1 - 2026
ER -