Managed care for uninsured patients at an academic health center: A case study

In 1997, the University of New Mexico Health Sciences Center ("the Center") created a managed care plan ("the Plan") for its uninsured patients who we re county residents. The Plan's features include Fooling the resources of e xisting 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. Af ter two years of the Plan's operation, the utilization of ambulatory care s ervices by Plan enrollees, the number of discharges per 1,000 enrollees fro m the Center-affiliated University Hospital, and the number of hospital day s 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 pa ying patients is estimated to have yielded over $695,000 in additional reve nues per year. The authors conclude that managing the care of uninsured patients in an aca demic health center can reduce ambulatory care and inpatient utilization an d reduce the cost of care. To achieve these favorable outcomes requires the organization of services to meet the unique needs of the uninsured and und erserved population.