Revisioning the Delivery of Health Care Services to Uninsured Patients in Harris County

After an initial focus on educating the public and promoting viable solutions to the area’s trauma capacity shortages, the leadership of Save Our ERs turned its attention to the general crisis of overutilization impacting hospital emergency rooms across the region. An earlier emergency department study commissioned by Save Our ERs found that 57 percent of the patients presenting themselves for care at local hospital emergency rooms had nonurgent or minor complaints.

In its recent strategic planning initiative, the Harris County Hospital District found that their system is funded at a level that provides healthcare access for only 23 percent of the County’s uninsured population. While there are additional private community clinics in Harris County, the County has only two federally-qualified health care centers (FQHCs), clinics that receive direct federal funding to care for the uninsured. Given the woeful inadequacy of the public health care system, it was clear that, with Houston and Harris County’s high rate of population growth and growing percentage of residents without health insurance, the hospital emergency rooms of this region will continue to be crowded with those needing access to basic health care.

Save Our ERs, with the financial support of Harris County Health Facilities Development Corporation, commissioned The Lewin Group to work with the community to analyze local health care utilization and provide a framework for revisioning the organization and delivery of health care services for the uninsured in Houston and Harris County. Beginning in the fall of 2003, The Lewin Group met and/or spoke with leaders in the local healthcare community to obtain their insight and recommendations. Via provider surveys, utilization data was collected and analyzed. An environmental scan was conducted of other municipalities or regions across the country that had experienced success in reducing health system fragmentation and improving coordination. Finally, three restructuring options were formulated.

Save Our ERs released the final report to the community on June 30, 2004 in a meeting open to the public and attended by more than sixty community and health care leaders and representatives from the City of Houston and the Harris County Commissioners Court. Dr. Guy Clifton, Chairman of Save Our ERs, challenged the community to implement Lewin’s most aggressive restructuring option, the development of a Coordinated Community Health System (CCHS), which would create a countywide coordinated network of new ambulatory care access points, expansion of care coordination and linkages at both the provider and community-based levels, consolidation of city and county public health departments, and the establishment of a high-level governance structure to oversee the CCHS and ensure access to health care for the uninsured in the most efficient and cost-effective manner. Mr. Rob Mosbacher, Chairman of the Greater Houston Partnership, expressed appreciation for the leadership shown by Save Our ERs and indicated that the The Lewin Group’s report will be utilized by the Partnership in its efforts to formulate a health care plan for the community.