Care coordination can help Medicaid stem costs of new enrollees

While a recent report indicated that newly eligible Medicaid enrollees may be more costly than anticipated to cover, a Health Affairs study points to one promising cost-reduction solution: Care coordination.

The study, published in the July edition of the journal, concerned a program for previously uninsured adults in California called the Health Care Coverage Initiative. Researchers found that when the program instituted payment policies that encouraged patients to stick with one primary care provider, it led to greater reliance on primary care services and a reduction in costly emergency department (ED) visits and hospitalizations.  

While the results underscore the importance of care coordination, perhaps more importantly, they demonstrate the power of "payment methodology and policy structures" to encourage continuity of care for Medicaid enrollees, a Health Affairs blog post points out. Still, the post notes, there is still much to learn about how payments to providers can influence care utilization. For instance, copayments and other restrictions on "unnecessary" ED visits have not always been effective in curbing ED overuse.

In the wake of the Supreme Court's ruling to uphold a key provision of the Affordable Care Act, some states that previously resisted Medicaid expansion have considered doing so. However, ballooning enrollment numbers have left some of the states that expanded the program worried about high costs, especially given the Centers for Medicare & Medicaid Services' office of the actuary report that found newly eligible beneficiaries cost Medicaid more, FierceHealthPayer reported.

However Medicaid expansion plays out, scores of long-term uninsured adults are likely to enter the system in coming years, the blog post notes. And programs like the Health Care Coverage Initiative show that "care coordination will ensure that continuously insured people receive the right care, while saving money for states and the Medicaid program."

To learn more:
- check out the study (subscription required)
- read the blog post

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