Use of urgent care centers and emergency department visits for non-urgent health conditions: an analysis of beneficiaries from a managed care organization

Research Objective: Urgent Care Centers (UCCs) are part of the U.S. health care delivery system reducing emergency department (ED) overcrowding, providing access, ease, quick service, and lower cost of care than ED. Managed care organizations (MCOs) have begun to partner with UCCs to treat non-urgent health conditions. Despite the rapid growth of the urgent care industry, few studies describe characteristics of beneficiaries from Medicaid/ Medicare MCO who use UCC. Our objective was to identify the characteristics of beneficiaries from a MCO who utilized UCC and compare them with ED users and those who used both for non-urgent health conditions. Study Design: With a cross sectional design, analyzed administrative claims data of a MCO from January to December 2016 (n=20,107). Outcome variables were number of visits to UCC, ED, or both. The MCO followed New York University algorithm for ED visit classification to identify non-urgent health conditions. We used the Behavioral Model of Health Care Utilization as a conceptual framework to identify the predictors in the model: age, gender, race/ethnicity, distance to UCC from residence (measured using Maptitude Software), type of insurance, primary care physician visits, inpatient admissions, chronic conditions, morbid obesity, and smoking behavior. Three Generalized Linear Models were used to analyze the association between outcomes and predictors. Population Studied: Study included Medicaid and Medicare beneficiaries from a single MCO who utilized UCC, ED or both for non-urgent health conditions. Beneficiaries resided within 10-mile radius or less of 12 UCC locations. Principal Findings: Among beneficiaries who had non-urgent health conditions (n=20,107), 22.7% were UCC users, 66.8% were ED users, and 10.5% used both. Average residential distance from UCC was 3 mile radius and about 93% lived within 5 mile radius of UCC locations. Both UCC and ED users were more likely to be females and Medicaid beneficiaries. African Americans [IRR: 0.95; 95%CI: 0.91-0.98] were less likely to use UCC and more likely to use ED [IRR: 1.10; 95% CI: 1.07-1.13). Those with higher number of chronic conditions were more likely to use ED than UCC. Distance was not a predictor of UCC or ED use. Conclusions: Although majority of the beneficiaries who had non-urgent health conditions resided within 5-mile radius of UCCs, less than one fourth utilized UCC, and 11% used either UCC or ED. African Americans and beneficiaries with higher number of chronic conditions were less likely to use UCC for non-urgent health conditions. UCC users were relatively healthier than ED users. Distance was not a predictor of either UCC, ED, or both use. Public Health Significance: Our study implies that although UCC were available within 5-mile radius for most beneficiaries and also to majority of African American beneficiaries, yet they were not utilizing it for non-urgent health conditions. Access alone may not help in utilization of UCC services. Interventions targeted at disseminating information to the community about UCC locations, services provided, and when they may use it, is equally important to improve utilization and reduce ED crowding and costs from non-urgent health conditions