Care Intervention and Reduction of Emergency Department Utilization in Medicaid Populations (original) (raw)
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Medicaid managed care and preventable emergency department visits in the United States
PLOS ONE
Objectives In the United States the percentage of Medicaid enrollees in some form of Medicaid managed care has increased more than seven-fold since 1990, e.g., up from 11% in 1991 to 82% in 2017. Yet little is known about whether and how this major change in Medicaid insurance affects how recipients use hospital emergency rooms. This study compares the performance of Medicaid health maintenance organizations (HMOs) and fee-for-service (FFS) Medicaid regarding the occurrence of potentially preventable emergency department (ED) use. Methods Using data from the 2003-2015 Medical Expenditure Panel Survey (MEPS), a nationally representative survey of the non-institutionalized US population, we estimated multivariable logistic regression models to examine the relationship between Medicaid HMO status and potentially preventable ED use. To accommodate the composition of the Medicaid population, we conducted separate repeated cross-sectional analyses for recipients insured through both Medicaid and Medicare (dual eligibles) and for those insured through Medicaid only (non-duals). We explicitly addressed the possibility of selection bias into HMOs in our models using propensity score weighting. Results We found that the type of Medicaid held by a recipient, i.e., whether an HMO or FFS coverage, was unrelated to the probability that an ED visit was potentially preventable. This finding emerged both among dual eligibles and among non-duals, and it occurred irrespective of the adopted analytical strategy.
MACFacts: Revisiting Emergency Department Use in Medicaid
Overview Medicaid enrollees' emergency department (ED) use accounts for just 4 percent of total Medicaid spending, but because Medicaid enrollees use the ED more frequently than both privately insured and uninsured persons, state Medicaid programs monitor ED use closely (MACPAC 2014). 1 The ED is an expensive place to treat medical problems because it maintains 24-hour staff and resource availability and the hospital settings in which most EDs are based have both high overhead and fixed costs. Thus, payers and health plans have long sought to keep costs down by educating patients about appropriate use of the ED and providing timely access to care in other settings. Higher ED use among Medicaid enrollees is explained mostly by the higher rates and more severe cases of chronic disease and disability they experience relative to those who are privately insured and uninsured (MACPAC 2012a, 2012b, Mortensen and Song 2008). High ED use also can be a sign of poor access to primary, spec...
Contrary to conventional wisdom that Medicaid patients often use hospital emergency departments (EDs) for routine care, the majority of ED visits by nonelderly Medicaid patients are for symptoms suggesting urgent or more serious medical problems, according to a new national study by the Center for Studying Health System Change (HSC). About 10 percent of nonelderly Medicaid patient ED visits are for nonurgent symptoms, compared with about 7 percent for privately insured nonelderly people. Nonetheless, there are clearly opportunities to develop less-costly care options than emergency departments for both nonelderly Medicaid and privately insured patients. To reduce ED use, policy makers might consider how to encourage development of care settings that can quickly handle a high volume of potentially urgent medical problems. Policy makers may want to focus initially on conditions that account for high ED volume that could likely be treated in less resource-intensive settings. For exampl...
Analysis of Emergency Department Utilization in Medicaid Expansion and Non-expansion States
Cureus, 2021
Introduction The Affordable Care Act has been debated since its initial enactment over a decade ago. One of the primary topics for discussion has been Medicaid expansion, which has created a schism across the United States. The effects of Medicaid expansion largely remain unclear. The purpose of this report is to elucidate how Medicaid expansion has impacted emergency department (ED) utilization by analyzing Medicaid expansion and non-expansion states to determine who visited the ED and the reason for the visit. Methods We conducted a retrospective analysis using de-identified electronic medical record (EMR) data from 56,423 patients and 33 different hospitals (18 Medicaid non-expansion and 15 Medicaid expansion) who visited the ED in 2019. We used geographical demographics and insurance status to categorize patients who visited the ED and ambulatory care sensitive conditions (ACSC) to identify the reasons for the visit. Logistic regression and chi-square analysis were used to analyze the data. Results We observed a significant relationship between Medicaid expansion and geographic region such that patients living in rural or semirural regions likely resided in Medicaid non-expansion states. Patients using self-pay were more likely to live in a Medicaid non-expansion state than a Medicaid expansion state (32.3% vs. 21.5%, p-value < 0.0001). Finally, there were no significant differences between the top five ACSC for Medicaid expansion and Medicaid non-expansion states but living in an expansion state was significantly (p < 0.01) related to being diagnosed with an ACSC (OR, 1.056; 95% CI, 1.013-1.100). Conclusion In conclusion, Medicaid expansion was associated with differences in the use of medical resources. Patients using Medicaid insurance who reside in Medicaid expansion states preferentially use the ED. Geographical location does play a role in ED utilization and ambulatory care sensitive condition diagnoses in patients. Despite these findings, the full effects of Medicaid expansion on ED utilization require further investigation. However, our research indicates that Medicaid expansion is not the singular solution in decreasing ED utilization and healthcare costs.
Reasons for Frequent Emergency Department Use by Medicaid Enrollees: A Qualitative Study
Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 2016
The Affordable Care Act initiated several care coordination programs tailored to reduce emergency department (ED) use for Medicaid enrolled frequent ED users. It is important to clarify from the patient's perspective why Medicaid enrollees who want to receive care coordination services to improve primary care utilization frequently use the ED. We conducted a qualitative data analysis of patient summary reports obtained from Medicaid enrolled frequent ED users who agreed to participate in a randomized control trial (RCT) evaluating the impact of patient navigation intervention compared with standard of care on ED use and hospital admissions. We defined frequent ED users as those who used the ED 4-18 in the past year. The study was conducted at an urban, teaching hospital ED with approximately 90,000 visits per year. The research staff conducted interviews (~30-40 minutes), regarding the patient's medical history, reasons for ED visits, health care access issues, and social di...
Health services research and managerial epidemiology, 2016
The objective of this study was to examine the association of patient- and county-level factors with the emergency department (ED) visits among adult fee-for-service (FFS) Medicaid beneficiaries residing in Maryland, Ohio, and West Virginia. A cross-sectional design using retrospective observational data was implemented. Patient-level data were obtained from 2010 Medicaid Analytic eXtract files. Information on county-level health-care resources was obtained from the Area Health Resource file and County Health Rankings file. In adjusted analyses, the following patient-level factors were associated with higher number of ED visits: African Americans (incidence rate ratios [IRR] = 1.47), Hispanics (IRR = 1.63), polypharmacy (IRR = 1.89), and tobacco use (IRR = 2.23). Patients with complex chronic illness had a higher number of ED visits (IRR = 3.33). The county-level factors associated with ED visits were unemployment rate (IRR = 0.94) and number of urgent care clinics (IRR = 0.96). Pat...
An assessment of emergency department use among Mississippi's Medicaid population
Journal of the Mississippi State Medical Association, 2015
National trends in Emergency Department (ED) use suggest Medicaid recipients visit the ED more frequently and make more non-emergent ED visits than those uninsured and privately insured. Given the absence of data on Medicaid beneficiaries in Mississippi, it is important to explore their ED utilization, particularly frequent and non-emergent ED visits. Medicaid claims data were used to calculate ED visit rates and identify common diagnoses within the Mississippi Medicaid population. Non-emergent ED visits were classified using the NYU ED algorithm. In 2012, 605,555 ED claims were made by 290,324 Medicaid beneficiaries in Mississippi, representing 43.7% of the Medicaid population (664,583). Twelve percent of ED users were frequent users (4 or more claims per year). Most claims (57.5%) were non-emergent, meaning they could have been treated in a primary care setting. High rates of non-emergent ED visits suggest gaps in primary care delivery for Mississippi Medicaid beneficiaries.
2020
To determine the impact of Medicaid expansion on access to preventative care and non-emergent emergency department (ED) use for existing Medicaid enrollees. Study Design: The primary and secondary outcomes were receipt of annual preventive care visit and non- emergent emergency department (ED) visits, respectively. A logistic state-level, matched, difference in difference regression model was used for the primary analysis and a Poisson specification was used for the secondary analysis. Models controlled for patient characteristics and accounted for the complex longitudinal survey design.
BMC Health Services Research, 2014
Background: Emergency department (ED) use is costly, and especially frequent among publicly insured populations in the US, who also disproportionately encounter financial (cost/coverage-related) and non-financial/practical barriers to care. The present study examines the distinct associations financial and non-financial barriers to care have with patterns of ED use among a publicly insured population. Methods: This observational study uses linked administrative-survey data for enrollees of Minnesota Health Care Programs to examine patterns in ED use-specifically, enrollee self-report of the ED as usual source of care, and past-year count of 0, 1, or 2+ ED visits from administrative data. Main independent variables included a count of seven enrollee-reported financial concerns about healthcare costs and coverage, and a count of seven enrollee-reported non-financial, practical barriers to access (e.g., limited office hours, problems with childcare). Covariates included health, health care, and demographic measures. Results: In multivariate regression models, only financial concerns were positively associated with reporting ED as usual source of care, but only non-financial barriers were significantly associated with greater ED visits. Regression-adjusted values indicated notable differences in ED visits by number of non-financial barriers: zero non-financial barriers meant an adjusted 78% chance of having zero ED visits (95% C.I.: 70.5%-85.5%), 15.9% chance of 1(95% C.I.: 10.4%-21.3%), and 6.2% chance (95% C.I.: 3.5%-8.8%) of 2+ visits, whereas having all seven non-financial barriers meant a 48.2% adjusted chance of zero visits (95% C.I.: 30.9%-65.6%), 31.8% chance of 1 visit (95% C.I.: 24.2%-39.5%), and 20% chance (95% C.I.: 8.4%-31.6%) of 2+ visits. Conclusions: Financial barriers were associated with identifying the ED as one's usual source of care but non-financial barriers were associated with actual ED visits. Outreach/literacy efforts may help reduce reliance on/perception of ED as usual source of care, whereas improved targeting/availability of covered services may help curb frequent actual visits, among publicly insured individuals.
Health affairs (Project Hope), 2016
In 2014 twenty-eight states and the District of Columbia had expanded Medicaid eligibility while federal and state-based Marketplaces in every state made subsidized private health insurance available to qualified individuals. As a result, about seventeen million previously uninsured Americans gained health insurance in 2014. Many policy makers had predicted that Medicaid expansion would lead to greatly increased use of hospital emergency departments (EDs). We examined the effect of insurance expansion on ED use in 478 hospitals in 36 states during the first year of expansion (2014). In difference-in-differences analyses, Medicaid expansion increased Medicaid-paid ED visits in those states by 27.1 percent, decreased uninsured visits by 31.4 percent, and decreased privately insured visits by 6.7 percent during the first year of expansion compared to nonexpansion states. Overall, however, total ED visits grew by less than 3 percent in 2014 compared to 2012-13, with no significant diffe...