New London County has the highest rate of avoidable emergency department visits in Connecticut with nearly half of all visits for non-urgent conditions, according to a report published by the Connecticut Health Foundation in 2018.
“It is an area that clearly the data shows that there is an issue there. I don’t know if the diagnosis is completely in, but they have the highest rate of unnecessary emergency room visits in the state of CT,” said Pat Baker, the president and CEO of the Connecticut Health Foundation.
According to the Connecticut Office of Health Care Access, nearly half of emergency department visits could be avoided through regular primary care. Therefore, the issue becomes, is primary care truly accessible to those living in New London county.
“You have to look at the provider network,” Baker said. “With fewer providers they have the ability to decide who they will take.”
In other words, private providers or providers based in large health systems may choose not to accept those on Medicaid or those without insurance.
“There could very well be a Hartford Healthcare or Yale New Haven Health outpatient service, but are they accepting Medicaid clients without huge waits? Are they accepting uninsured clients? Federally qualified community health centers offer care regardless of if you’re able to pay,” said Jen Granger, the president and CEO of United Community and Family Services based in New London County.
The organization which opened in 1877 along with the other community health centers in the area provide services to 51 percent of the Medicaid population in New London County and 44 percent of the uninsured. If the rest of the medicaid and uninsured populations are being served through hospital networks, or not at all, is unclear.
Across the board in New London county, whether it is a large hospital system or a community health center, all are challenged with the task of recruiting primary care physicians to the area.
Residency programs are “graduating fewer and fewer primary care doctors and of those that are in the market, how many of them want to work with a low-income population?” Granger said.
All healthcare organizations spend a lot of money – upward of $30,000 per candidate when a recruiting firm is used – to entice doctors to the area.
“We need to show the physicians what the area has to offer. We invite them with their spouse to dinner, drive them to different neighborhoods, it is a whole marketing effort,” Granger said.
Although finding a provider can be difficult, especially when fewer are moving to the area, most people who work in the community health recognize that other barriers – like housing, food insecurity and transportation – often referred to as the social determinants of health are actually the reason for individuals not getting regular medical attention.
The Thames Valley Council for Community Action in New London County (TVCAA) works on helping individuals overcome these barriers to healthcare whether that means helping them find transportation or going through their finances in detail to see if there are any assistance programs they could apply for in order to spare money for medical costs, said Deb Monahan, the executive director for TCVAA.
TCVAA, along with many community health centers, also helps individuals complete applications for programs like food stamps, WIC, insurance through Access Health CT during open enrollment and medicaid if they are eligible. Just this year, UCHS actually opened up an emergency food pantry within their health centers because so many clients were coming in hungry.
“We were hearing heartbreaking stories from clients about not having enough food,” Granger said. “Some doctors were even giving out ten dollars for patients to go buy McDonalds for their family.”
In 2017, just after the Lawrence and Memorial Hospital (L&M) affiliated with Yale New Haven Health System TVCAA began collaborating with them to address these barriers and better coordinate care to prevent unnecessary emergency room visits and noncompliance with medical treatment. At the same time Yale New Haven Health System had received a grant from the Center for Medicare and Medicaid Services to work directly on addressing social determinants of health.
“We are working with discharge planners to identify a patient who is high risk for rehospitalization or going to the emergency room frequently,” Monahan said. TCVAA is working with L&M to address the social determinants of health that the individual is struggling with.
For example, helping someone who is unable to pay the co-pay for their prescription medication so they do not end up needing emergency care for a preventable problem.
“I think what it is, is that people are recognizing that we can’t do things in isolation. If you look a little deeper you can see that there is a food insecurity issue or housing is unstable,” Monahan said. The increased collaboration with L&M “is more an acknowledgement that we are connected and not isolated in our silos.”
Since L&M’s affiliation with Yale New Haven Health, specialty services available within the region have increased greatly as well. Instead of residents routinely having to travel to Hartford or New Haven for care, many services are now provided in New London.
“The affiliation with Yale New Haven Health has had great impact on the care we provide our patients,” said Michael O’Farrell, the director of public relations for L&M. A consistent result of the affiliation has been, “more providers and specialists providing services locally that previously would have required a patient to receive care somewhere else.”
Some of the additions include advances in neurosurgery and urology treatment as well as cardiovascular care post heart attack.