No Place to Call Home — Policies to Reduce ED Use in Medicaid

Friedman, Ari B; Saloner, Brendan; Hsia, Renee Y.

doi:10.1056/nejmp1502627

Cited by 17 publications

(13 citation statements)

References 5 publications

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“…In the long-standing policy debate about how to reduce potentially preventable ED use, lower costs, and reduce ED crowding, a proposed approach has been to improve access to high-quality primary care for underserved children who disproportionately use the ED. 16,29 The logic behind this strategy is based on evidence that underserved children, particularly those without insurance or who are on Medicaid, have worse access to primary care compared with their privately insured counterparts. 30 -32 In addition, parents bringing children to the ED often cite poor access to primary care as a primary driver of that visit.…”

Section: Discussionmentioning

confidence: 99%

“…14,15 The Affordable Care Act has also provided funding for hundreds of new FQHC locations nationwide to improve primary care access for growing numbers of newly insured vulnerable people seeking medical care. 15 Although improved access to primary care, such as FQHCs, for vulnerable populations is often suggested as a potential solution to the problem of potentially preventable ED use by children and adults, 16,17 no studies have investigated the independent association between FQHC access and ED utilization among children. Furthermore, existing studies on the association between access to FQHCs and acute care use that do not stratify by age or focus on adults specifically have largely been cross-sectional, 18 -20 focused on hospitalizations, 21 or limited to a single clinic.…”

Section: What This Study Addsmentioning

confidence: 99%

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Federally Qualified Health Center Access and Emergency Department Use Among Children

Nath

Costigan

Lin³

et al. 2016

Pediatrics

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Whereas increased geographic FQHC access was associated with lower rates of ED use by uninsured children, all other measures of FQHC access were not associated with statistically significant changes in pediatric ED use. These results provide community-level evidence that expanding FQHCs may have a limited impact on pediatric ED use, suggesting the need to explore additional factors driving ED utilization.

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Section: Discussionmentioning

confidence: 99%

Section: What This Study Addsmentioning

confidence: 99%

Federally Qualified Health Center Access and Emergency Department Use Among Children

Nath

Costigan

Lin³

et al. 2016

Pediatrics

Self Cite

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show abstract

“…This has been shown to be influential in non-emergent ED use in rural locations, as 50% of ED visits made by individuals living in a rural area have been non-emergent [ 9 ]. The number of non-emergent care sources in a location has also been shown to be influential in one’s use of the ED for non-emergent care [ 30 ]. An individual will seek out care based on what is available to them [ 31 ].…”

Section: Introductionmentioning

confidence: 99%

Mental Health and Drivers of Need in Emergent and Non-Emergent Emergency Department (ED) Use: Do Living Location and Non-Emergent Care Sources Matter?

McManus

Cramer

Boshier

et al. 2018

IJERPH

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Emergency department (ED) utilization has increased due to factors such as admissions for mental health conditions, including suicide and self-harm. We investigate direct and moderating influences on non-emergent ED utilization through the Behavioral Model of Health Services Use. Through logistic regression, we examined correlates of ED use via 2014 New York State Department of Health Statewide Planning and Research Cooperative System outpatient data. Consistent with the primary hypothesis, mental health admissions were associated with emergent use across models, with only a slight decrease in effect size in rural living locations. Concerning moderating effects, Spanish/Hispanic origin was associated with increased likelihood for emergent ED use in the rural living location model, and non-emergent ED use for the no non-emergent source model. ‘Other’ ethnic origin increased the likelihood of emergent ED use for rural living location and no non-emergent source models. The findings reveal ‘need’, including mental health admissions, as the largest driver for ED use. This may be due to mental healthcare access, or patients with mental health emergencies being transported via first responders to the ED, as in the case of suicide, self-harm, manic episodes or psychotic episodes. Further educating ED staff on this patient population through gatekeeper training may ensure patients receive the best treatment and aid in driving access to mental healthcare delivery changes.

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“…[1][2][3][4] State Medicaid programs have proposed different policies to reduce ED visits including requiring Medicaid patients to make higher co-payments for their ED visits or providing Medicaid patients with robust alternative services to ED care through patient-centered medical home models. 5 However, those policies may have limited effectiveness if they are based on incorrect assumptions about the underlying reasons for high rates of ED use in the Medicaid population.…”

Section: Introductionmentioning

confidence: 99%

Comparing Emergency Department Use Among Medicaid and Commercial Patients Using All-Payer All-Claims Data

Kim

McConnell

Sun

2017

Population Health Management

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The high rate of emergency department (ED) use by Medicaid patients is not fully understood. The objective of this paper is (1) to provide context for ED service use by comparing Medicaid and commercial patients' differences across ED and non-ED health service use, and (2) to assess the extent to which Medicaid-commercial differences in ED use can be explained by observable factors in administrative data. Statistical decomposition methods were applied to ED, mental health, and inpatient care using 2011-2013 Medicaid and commercial insurance claims from the Oregon All Payer All Claims database. Demographics, comorbidities, health services use, and neighborhood characteristics accounted for 44% of the Medicaid-commercial difference in ED use, compared to 83% for mental health care and 75% for inpatient care. This suggests that relative to mental health and inpatient care, a large portion of ED use cannot be explained by administrative data. Models that further accounted for patient access to different primary care physicians explained an additional 8% of the Medicaid-commercial difference in ED use, suggesting that the quality of primary care may influence ED use. The remaining unexplained difference suggests that appropriately reducing ED use remains a credible target for policy makers, although success may require knowledge about patients' perceptions and behaviors as well as social determinants of health.

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No Place to Call Home — Policies to Reduce ED Use in Medicaid

Cited by 17 publications

References 5 publications

Federally Qualified Health Center Access and Emergency Department Use Among Children

Federally Qualified Health Center Access and Emergency Department Use Among Children

Mental Health and Drivers of Need in Emergent and Non-Emergent Emergency Department (ED) Use: Do Living Location and Non-Emergent Care Sources Matter?

Comparing Emergency Department Use Among Medicaid and Commercial Patients Using All-Payer All-Claims Data

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