Care Coordination: Connect to Care Program
Connect to Care Program
For many years, nearly half of emergency department (ED) visits in Milwaukee County have been for non-emergencies, with many of those visits made by uninsured or underinsured individuals lacking a primary care provider. Since 2009, the MHCP’s Emergency Department to Medical Home Program (EDMH), now referred to as the Connect to Care Program, has worked to:
- Decrease avoidable emergency room visits and related hospitalizations
- Reduce duplicative emergency room tests and procedures
- Connect high-risk individuals with primary care health homes and other health resources
The Connect to Care Program has demonstrated a 44% reduction in subsequent ED usage among patients connected to primary care.
Evidence-based screening and patient engagement practices, supported by a community-wide appointment scheduling software (Experian Patient Schedule / MyHealth Direct), allow ED, inpatient, and community-based discharge planners to directly schedule a real-time follow-up appointment before the person leaves the ED or point of care. The goal of the Connect to Care Program process is to connect high-risk people with long-term health homes to better address their continuing health needs. More than 60,000 appointments have been scheduled to date through this program.
In 2023, the program brought on additional referral and receiving partners beyond EDs and primary care medical homes. To reflect this expansion in scope, the EDMH Program was renamed the Connect to Care Program. Referral organizations now include ED and inpatient hospitals, mobile health units, community-based clinics, health department clinics, and community paramedics. Receiving organizations include Milwaukee County Federally Qualified Health Centers (FQHC), an FQHC Look-a-Like clinic, and community-based substance use clinics. Appointments are scheduled for primary care, behavioral health, substance use, and dental services for patients of all ages.
The Robert Wood Johnson Foundation’s focus on appropriate emergency department use provides key lessons learned by regional alliances in their Aligning Forces for Quality communities – including Milwaukee – as they work to transform local health care and provide models for national reform.