The Impact of Mercy Health Center on Healthcare Utilization and Costs

Background: Mercy Health Center (MHC) is a faith-based health resource center serving the underserved population across six Georgia counties. The staff and volunteers provide free healthcare to the uninsured including primary care, pharmacy, dental, chronic disease management, and behavioral health counseling. The purpose of this analysis is to explore the impact that MHC has on the healthcare utilization of its patients over time and the associated healthcare costs.

Methods: A cohort of 185 adult patients was identified, and 27 months of hospital utilization was recorded (9 months pre-MHC and 18 months post-MHC). MHC utilization during this period was also recorded. After attaching unit costs to MHC visits, emergency department usage, and outpatient services, we analyzed healthcare utilization and costs over time. Simple analyses included non-parametric longitudinal comparisons of utilization by category and of total healthcare costs. Some simple assumptions were made regarding the trajectory of healthcare utilization beyond the 18-month follow-up period. Further, a recurrent event survival analysis of each category of healthcare utilization was conducted using a stratified Cox proportional hazard model and the gap time approach.

Results: Emergency department utilization decreased and outpatient services increased after patients gained access to primary care through MHC. The primary healthcare category of healthcare savings was found to be from a reduction in emergency department visits. However, estimated healthcare cost savings were not large enough during follow-up to offset MHC costs. Overall, results were confirmed in the survival analysis as the risk for emergency department decreased significantly following access to MHC.

Discussion: Though net cost savings were not realized within the first 18 months at Mercy for this cohort, we would expect cumulative net cost savings to begin to accrue after a patient’s second year at MHC. Our results suggests that investment in a local free clinic can decrease unnecessary emergency department utilization and eventually lead to cost savings for the healthcare system.

Limitations: Patient data were gathered from two local hospital databases, as well as from MHC, leading to three specific limitations. First, verification of patient residence in the service area during the full 27-month period was not possible. Second, we did not have data on healthcare utilization outside of the service area or from local private clinics. Finally, our analysis did not consider medication costs, as these data were not available to the research team.