The Center for Studying Health Systems Change recently published its findings from a national survey that found that people reporting difficulty reaching their Primary Care Provider (PCP) after hours were significantly more likely to use the emergency department or go without needed care.
Of the 9,577 survey respondents who said they have a usual source of primary care (PCP), 1,470 reported that they attempted to contact their PCP after hours in the past year. Of that group, 20.8 percent said it was "very difficult" or "somewhat difficult" to reach their PCP after hours.
The reported use of the emergency department was 37.7 percent for people who had a difficult time contacting their PCP after hours versus 30.4 percent for those reporting less difficulty with after-hours access. The rate of people going without needed care was also higher for those reporting difficulty with after-hours access: 13.7 percent versus 6.1 percent for those reporting less difficulty.
Illinois Health Connect requires its enrolled PCPs and medical homes to provide 24/7 coverage for IHC clients. This after-hours access must be in the form of an answering service/paging mechanism, or other approved arrangements. Automatic referral to a hospital emergency department does not qualify.
PCPs who do not comply with this component of the IHC Primary Care Provider Agreement are at risk of termination from the IHC program. IHC Quality Assurance Nurses (QAN) will work with practices to help them meet this requirement and avoid unnecessary emergency department use.
QANs are available to meet with IHC providers on an appointment basis to support the work of medical homes through the use of IHC Quality Tools and other clinical trainings. Contact information for QANs is available on the IHC Provider Portal, which can be accessed through the HFS MEDI System, or by calling the IHC Provider Services Help Desk at 1-877-912-1999, extension 3.
