In 2023, the U.S. Census Bureau estimated nearly five million Texans were uninsured or underserved, often relying on emergency departments for their medical needs. These patients frequently leave the hospital with instructions to follow up with their primary care physician or a specialist. But what happens when they lack access to a medical home or cannot afford specialty care? Many find themselves in a vicious cycle of health issues exacerbated by the absence of health insurance.
It’s taking medical psychosocial complexity and partnering that with teams of people who have resources to change the trajectory of their life.
Jeffrey Zsohar, MD, Medical Director of BSW Community Care Clinics
This is where Baylor Scott & White Health (BSWH) steps in with its innovative community care strategy. By providing a network of physicians, clinics and support programs. BSWH empowers people to manage their health proactively, which is especially important for patients with chronic conditions. The Community Care Clinics fill an important gap, providing patients with a medical home and connecting them with social services and free or low-cost medications.
Across North Texas, nine such BSW clinics are making a significant impact on patient care. These clinics are designed to address the needs of rising-risk populations and improve the quality of care for patients who typically visit emergency rooms for on-going illnesses requiring complex case management.
It is estimated that 5% of patients account for 50% of all medical costs. Therefore, implementing innovative support for the underserved population, many who suffer from chronic diseases such as diabetes, can lead to significant improvements. By providing patient monitoring, education, and support through Community Care teams, hospitals have seen aa 46% hospital cost reduction when patients are engaged with these services. This approach not only reduces healthcare expenses but also improves patient outcomes and quality of life for those with chronic conditions.
One shining example is the Fort Worth Community Care Clinic, where Dr. Nathan Smith and Nurse Practitioner Maurilia Foster, dedicate their time to understanding and addressing the unique needs of their patients. In the last year, they have seen 1,846 unique patients, resulting in approximately 5,000 encounters and welcoming 72 new patients into the clinic. Of these patients, over 300 were referred to BSW-affiliated specialists for free care subsidized by BSWH and philanthropic efforts. The most needed specialists included gynecology, cardiology, ear nose and throat services, as well as endocrinology. However, the demand for specialty care continues to grow, highlighting the need to expand the provider network further.
The Baylor Scott & White All Saints Health Foundation has recently partnered with the community clinic to address specialty care access through a Hearing Aid program, funded through a generous grant from the Goodrich Center for the
Deaf. This pilot program provides free audiology services and treatment, including hearing aids, to hard-of-hearing patients from medically underserved populations. These patients are unable to obtain or afford these essential services, which typically are not covered by insurance and can cost thousands of dollars
The Community Care Clinic has demonstrated success across the various locations within the Baylor Scott & White system. By decreasing emergency department visits, the clinic has reduced inpatient direct care costs are decreasing and created more space for others in need of care. Ultimately, it is the patients who win.
Looking ahead, the Foundation is eager to expand its efforts in addressing additional healthcare needs for this underserved population.
