MetroHealth creates regionalized Medicaid program

MetroHealth, Cleveland's primary safety-net hospital, used a miniaturized Medicaid program for its service region to increase coverage and improve outcomes, National Public Radio reports.

MetroHealth put aside $30 million in local taxpayer funds to create the program, which focuses on low-income residents who may earn too much to qualify for Medicaid coverage or, in some cases, do not even bother to apply. Enrollment cards were automatically sent out to 18,000 residents of Cuyahoga County who were frequent users of the MetroHealth emergency department (ED). They were selected via the use of a sophisticated electronic medical records system. Patients were also assigned nurses to monitor the care they received.

As a result, ED visits to MetroHealth dropped by 60 percent during the first nine months of the program, and primary care visits rose by 50 percent. Care also cost $150 less a month per patient than MetroHealth officials had originally estimated, while patient outcomes improved dramatically.

"The diabetes outcomes were probably the most impressive," Randy Cebul, M.D., of MetroHealth, told NPR. "The sugar control, the blood pressure control, the lipid control--virtually everything was much better and dramatically so ... better care, better outcomes, better costs."

There have been a variety of providers that started up miniaturized Medicaid programs for their service areas, but NPR noted that their results are mixed. One of the most notable ones has been a consortium of some 200 providers in upstate New York, using a chunk of $8 billion in federal waiver money in order to do so. Like MetroHealth, it focused on reducing unnecessary ER visits among its Medicaid population.

MetroHealth, which is operated by Cuyahoga County, wanted to reduce the stream of uninsured patients to its emergency department. In 2009, it implemented a $150 charge for any uninsured patient outside of the county who showed up at its doorstep.

To learn more:
- read the NPR article