Medical homes cut unnecessary ER use dramatically

The use of medical homes with a low-income population in California dramatically reduced unnecessary hospital emergency room visits, California HealthLine reported.

According to data compiled by researchers at the University of California at Los Angeles, low-income residents who enrolled and remained in medical homes were half as likely as those not in medical homes to use the ER for care that did not lead to a hospitalization.

Altogether, there were 606 ER visits without a hospitalization per 1,000 patients when the program began, a three-year Medicaid demonstration project know as the Health Care Coverage Initiative (HCCI). By the end of three years, the rate of ER visits among those who stayed in a medical home dropped to 295 per 1,000.

"In the context of expansion of Medi-Cal (California's Medicaid program) and increased healthcare coverage through the exchange, this is important," Nadereh Pourat, lead researcher of the study, told California HealthLine.

Medicaid enrollees and their use of the ER has been a contentious issue, with providers claiming it often drives up cost. A recent study by the National Bureau of Economic Research suggested a strong correlation between Medicaid expansion and ER use. However, the use of coordinated care in Oregon's Medicaid program was also successful in cutting frequent ER usage.

In an interview with FierceHealthFinance, Pourat noted that those enrolled in California's Health Care Coverage Initiative received counseling from caseworkers assigned to the medical homes where they received primary care. In one instant, Kern Medical Center in the city of Bakersfield kept a caseworker at its ER in order to steer program participants to forms of care more appropriate to their medical condition.

Although there were no cost data provided with UCLA's nearly 300-page study on the HCCI program, Pourat did confirm that it was significantly less expensive to treat patients in primary care settings than in the ER. And those in the program who had medical homes were also half as likely to be hospitalized than those without, according to the study data.

To learn more:
- read the California HealthLine article
- check out the UCLA study