Influence of Medicaid Managed Care Enrollment on Emergency Department Utilization by Children

Abstract

Children with all of their Medicaid enrollment in managed care have the lowest ED utilization rates for complex and noncomplex services. These results suggest that reducing delays in managed care plan enrollment may be an effective strategy to reduce ED utilization for this population.

Emergency Department Reliance Among Rural Children in Medicaid in New York State

“…In our study, children aged 3 to 6 years and adolescents in FFS Medicaid were significantly more likely to be EDR than children enrolled in MMC. Likewise, a study reveals that children enrolled in MMC have lower rates of ED visits than those in FFS, lower costs, and better cost containment 26 . Unfortunately, rural counties often do not have access to managed care plans, unlike their metro counterparts.…”

Methods of Categorizing Emergency Department Visit Urgency

“…These methods included (1) implicit criteria where determination of urgency is based on the expert opinion of physicians after medical chart review, 19,20 (2) explicit criteria where urgency is based on adherence to prespecified criteria after a review of an ED record, 4,21 -23 (3) resource utilization where urgency is determined by the resources used during the visit, 16,17 (4) International Classification of Disease (ICD) codes or diagnoses in which urgency is based on a list of predesignated diagnoses, 10,11 (5) Current Procedural Terminology (CPT) codes where urgency depends on the visit complexity as indicated by the 5 evaluation and management billing levels, 13 and (6) ED triage category. These methods included (1) implicit criteria where determination of urgency is based on the expert opinion of physicians after medical chart review, 19,20 (2) explicit criteria where urgency is based on adherence to prespecified criteria after a review of an ED record, 4,21 -23 (3) resource utilization where urgency is determined by the resources used during the visit, 16,17 (4) International Classification of Disease (ICD) codes or diagnoses in which urgency is based on a list of predesignated diagnoses, 10,11 (5) Current Procedural Terminology (CPT) codes where urgency depends on the visit complexity as indicated by the 5 evaluation and management billing levels, 13 and (6) ED triage category.…”

What′s new in emergencies trauma and shock? Outpatient follow-up after traumatic injury: Challenges and opportunities

“…Insurance coverage and type are known to be associated with patient age. [ 2 3 4 ] Other studies have reported age- and gender-related patterns in both recidivism and in the likelihood of presenting for scheduled post-discharge follow-up care among trauma patients. [ 5 6 ] In addition, the absence of detailed information on individual patient comorbidities may bias the study findings.…”