Ohio Experiment Shows Way To Save Money With Medicaid Expansion And Avoid Increase In ER Utilization

Opponents of the expanded Medicaid program have often cherry-picked data from Oregon to point out an increase in Emergency Room use and to question the benefits of the program. NPR’s Morning Edition looked at a program in Ohio to expand Medicaid coverage before the expansion in the Affordable Care Act and found positive results. The program was formed due to the problem of unreimbursed high cost care when uninsured people with problems such as diabetes received their care in the emergency rooms:

So, long before Ohio expanded Medicaid, the hospital redirected more than $30 million it receives from county taxpayers each year into a new pot.

It used the money to create its very own Medicaid program for county residents. And then it tracked the patients.

The results from the first nine months are in.

“All of the clinical outcomes are really amazing,” says , a researcher at MetroHealth.

The hospital used extensive electronic medical records to carefully select uninsured patients and send them Medicaid cards before they even applied. Then MetroHealth gave personalized attention to patients. Cebul says they focused on 18,000 of them who came to the hospital a lot.

“The diabetes outcomes were probably the most impressive,” he says. “The sugar control, the blood pressure control, the lipid control — virtually everything was much better and dramatically so.”

Here’s how it works. Each patient is assigned a nurse. That nurse books their appointments, calls them if they miss one and checks to make sure they take their medications.

In nine months, emergency department visits dropped 60 percent and primary care visits went up 50 percent.

The hospital also ended up spending less than it budgeted, saving an average of $150 on each patient every month.

“Better care, better outcomes, better costs,” Cebul says.

This program is probably showing better outcomes earlier than in Oregon due to increased oversight of the people receiving benefits. If people are just given health care coverage, it takes time to get established with primary care physicians as opposed to utilizing the Emergency Rooms. The experiment in Ohio showed that this problem could be avoided by making a greater effort to supervise the newly insured and actually set them up with primary care doctors.

Not surprisingly, the states which are participating in the expanded Medicaid program are seeing the largest drops in uninsured. It will be interesting to see how the individual states handle their new Medicaid patients, as the program in Ohio has demonstrated that there could be greater potential cost savings when the newly insured receive greater oversight, at least for those with expensive medical problems such as diabetes.

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