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Julia Field Costich, PhD, JD, School of Public Health, University of Kentucky, 121 Washington Ave, Lexington, KY 40536, 859-257-8709, jfcost0@uky.edu
The Southeast Kentucky Community Access Program (SKYCAP) has won national acclaim for its service to low-income uninsured residents of four Appalachian counties. This study assesses its reduction of emergency department visits and hospitalizations in the target population and suggests directions for further inquiry regarding elements of successful CAPs. We compared service utilization by SKYCAP enrollees in the 12 months before SKYCAP enrollment with utilization in the 12 post-enrollment months, noting variation by targeted health problem and type of service. We derived estimates of cost savings associated with charity care avoided by appropriate case management using median reimbursement rates for the same or similar services. SKYCAP’s success is particularly noteworthy because it operates in one of the most under-resourced health care regions in the nation. The savings in unreimbursed emergency department and inpatient hospital care alone for SKYCAP clients were more than twice (244%) HRSA’s investment. Emergency department visits were reduced by 92 percent and hospitalizations by 88 percent across all diagnoses. Clients were enrolled in a variety of programs for which they were eligible, including vocational rehabilitation, disability coverage, and pharmaceutical manufacturers’ prescription drug assistance programs. The greatest savings were realized for clients with diagnoses that posed the highest risk of true health emergencies, notably heart disease, for which there were 171 fewer admissions in the 12 months following enrollment than in the preceding 12 months. However, SKYCAP is under constant threat from two important quarters: loss of federal funding with the closing of the CAP initiative, and loss of access to free health care for its clients because of the inability of participating providers to shoulder the economic burden. SKYCAP has been economically beneficial to hospitals in its service area and has improved the quality of life for the large majority of its clients at strikingly low cost. This outcome has been achieved by attending to clients’ essential health care needs, notably prescription drugs and outpatient services. Savings have been realized primarily by the hospital sector, while costs in the form of uncompensated care have been borne primarily by physicians in the SKYCAP service area. For those physicians who are not hospital employees, this pattern of cost-shifting may make SKYCAP difficult to sustain. Loss of federal funding in this under-resourced region could also mark the end of SKYCAP. The striking success and low unit cost of the program argue in favor of continued funding.
Learning Objectives:
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.