Community program for Medicaid patients cuts ED use and boosts primary care visits

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A community program designed to increase primary care visits among Medicaid patients successfully reduced emergency department visits among this population by nearly 30 percent, according to a study published in Health Affairs.

For the study, researchers at the University of Colorado Anschutz Medical Campus in Aurora identified local Medicaid enrollees with high rates of ED use in multiple hospitals throughout the community. Researchers defined high ED use as having two or more ED visits or hospital admissions within 180 days.

Researchers enrolled 406 of these Medicaid recipients in the community care program. Each individual received a tailored 60-day care plan, which could include transportation access, guidance on applying for disability benefits or assistance filling prescriptions, among other services. Researchers compared the health outcomes of these enrollees with more than 3,000 other Medicaid recipients who met the eligibility criteria for the program, but were not enrolled for various reasons.

After six months, program participants had 29.7 percent fewer ED visits, 30 percent fewer hospitalizations and 123 percent more primary care visits than the control group.

"There is a perspective from multiple stakeholders that high users of the ED are difficult patients," said Roberta Capp, MD, an assistant professor of emergency medicine at Aurora-based University of Colorado School of Medicine and the study's first author. "But this study shows that patients use the ED because there are serious barriers to care … We believe that our success stems from bringing together different healthcare systems, breaking down silos between disciplines and focusing on continuity of care in the outpatient setting."

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