The report, “Hospital Utilization Patterns in 13 Low Income Communities in New Jersey: Opportunities for Better Care and Lower Costs,” examines hospital utilization patterns in 13 low-income communities to determine improvement opportunities for the New Jersey Medicaid ACO Demonstration Program. Each community has at least 5,000 Medicaid beneficiaries, which is the minimum required for forming a Medicaid ACO.
There was substantial variation between the regions:
• Emergency department high users — 4.7 fold variation
• Avoidable ED visits — 3.5 fold variation
• Avoidable inpatient stays — 2.3 fold variation
• Inpatient high use — 1.7 fold variation
• 30-day readmissions — 1.4 fold variation
If all 13 regions performed at the level of the region with the lowest cost profile, based on New Jersey uniform billing hospital discharge data from 2008 to 2010, the following savings could be achieved:
• $284 million from reduced inpatient high user costs
• $155 million from reduced avoidable inpatient stay and ED visit costs
• $94 million from reduced readmission costs
• $70 million from reduced ED high user costs
These savings should not be summed due to overlap in visits across measures, according to the report.
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