Connecting Safety Net Patients to Specialty Care Providers in Denver
When Medicaid and uninsured patients needed specialty care, finding providers willing to see them in a timely manner was a major challenge. Colorado’s decision to expand Medicaid under the Affordable Care Act (ACA) had increased the number of residents with health care coverage. Over 380,000 more Coloradans had Medicaid at the end of 2014 than at the start of the year, representing a 49.2% increase in the Medicaid caseload.¹ In Denver, 60,000 more people had Medicaid at the end of 2014 than at the start of the year, contributing to an estimated increase in the rate of health insurance coverage in the city from 83% to 94%. This phenomenal growth in Medicaid coverage led to increased access for Denver’s low-income residents to many areas of care, but has exacerbated challenges in accessing specialty care.
Making sure that Medicaid enrollees and the remaining uninsured had access to specialty care strengthened the impact of health reform. Denver Health and the Mile High Health Alliance worked to build a streamlined, technologically advanced referral hub to connect patients of Denver’s primary care safety net clinics serving publicly insured, under-insured and uninsured residents to specialists throughout the city. This specialty care referral hub aimed to improve access in the following ways:
- Problem: Denver’s safety net primary care providers relied primarily on informal, ad-hoc relationships to find specialty care for their patients.
- Solution: Provide a single, reliable mechanism for making specialty care referrals.
- Problem: Barriers such as transportation needs and language differences made it difficult for some publicly insured and uninsured patients to access specialty care.
- Solution: Case management services ensured that patients had the resources they needed to keep appointments with specialists and communicate effectively during appointments.
- Problem: Specialist providers were concerned that accepting Medicaid or uninsured patients would be unsustainable to their practices.
- Solution: Allow specialists providers to specify the number of patients they are willing to serve in a given time period.
- Problem: Appointment slots with specialists were limited, but were not always used for the patients who need them the most.
- Solution: Connect primary care and specialty care electronically through an eConsult system, reserving in-person appointments for situations that require this type of interaction.
The Specialty Care Access Group of the Mile High Health Alliance learned from pioneering collaborative work to improve access to specialty care in other communities. eConsult or eReferral programs in San Francisco and Los Angeles had electronically connected safety net primary care and specialty care providers. Many communities had developed programs to connect uninsured patients to volunteer specialty care providers. The Denver specialty care referral hub uniquely combined both eConsults and a community-wide referral mechanism to make the most efficient use of specialty care capacity in Denver.
Resources and Support from the National Partnership
To support the Denver partners in this effort, the National Partnership for the Health Care Safety Net provided information about successful specialty care access programs in other areas of the country. Members of the National Partnership presented these findings to a meeting of stakeholders in Denver in December 2014. The National Partnership also explored how state-level policies, such as reimbursement for telehealth services, may have impacted the referral hub.