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Twice as many Medicaid patients visit the ER as their insured counterparts, largely due to barriers to primary care access, according to a study published online in the March 2012 in Annals of Emergency Medicine.

5 Interventions to Reduce Avoidable ER Use by the Medicaid Population looks at the collaborative effort among five regions of Ohio to target the key reasons for avoidable ER visits among Medicaid beneficiaries and roll out test interventions in a rapid cycle quality improvement approach.

This 30-page resource describes the 18-month population-based and patient-centered pilot to curtail wasteful healthcare utilization in Ohio ERs, especially by those Medicaid beneficiaries identified as "Ultra Utilizers."

This exclusive report also presents select benchmarks on reducing avoidable ER use from 2011 market research by the Healthcare Intelligence Network.

ED utilization in Ohio was almost 30 percent higher than the national average, according to a 2008 survey conducted by American Hospital Association. About two-thirds of the utilization in Ohio EDs by Medicaid beneficiaries was considered non-emergent, PCP treatable and avoidable.

Sketching out the framework of the pilot is Mina Chang, Ph.D., chief, health services research and program development section of the Bureau of Health Services Research for the Ohio Department of Job & Family Services.

This report provides details on:

• Structure of the Ohio Medicaid quality improvement team;
• Patient population identification strategy;
• Priority populations;
• The five targeted interventions and early outcomes: Upper Respiratory Infections, Ultra Utilizers with Severe Mental Illness, Ultra Utilizers with Back Pain, Ultra Utilizers in the Non-Mental Health Population, and Dental Care in the ED;
• Strateges to 'spread' the intervention — taking the successful process and replicating that change;
• Selected benchmarks on interventions to reduce avoidable ER utilization from the 2011 Healthcare Intelligence Network survey on this topic;

Table of Contents

• Ohio Medicaid Quality-Based Interventions to Reduce Avoidable Medicaid ER Visits
  • Ohio IMPROVE Collaborative
  • Identifying Populations for Test Interventions
  • 3 Questions to Ask Patients
  • Intervention 1: Upper Respiratory Infections
  • Intervention 2: Ultra Utilizers with Severe Mental Illness
  • Intervention 3: Ultra Utilizers with Back Pain
  • Intervention 4: Ultra Utilizers in the Non-Mental Health Population
  • Intervention 5: Seeking Dental Care in the ED
• 2011 Benchmarks in Reducing Avoidable ER Use
  • Population Generating Avoidable ER Visits
  • Condition Generating Avoidable ER Visits
  • Frequently Presented Problem in High Utilizers
  • Strategies to Discourage Avoidable ED Visits
  • Staffing Solutions to Discourage Avoidable ED Usage
  • Engaging PCPs to Reduce ED Visits
• Q&A: Ask the Experts
  • Targeting Regions for the Interventions
  • Why Rapid Cycle Quality Improvement?
  • Priority Populations for Interventions
  • Beneficiary Accountability for Utilization
  • Screening for Non-Emergent Patients
  • Analyzing Data on URI Intervention
  • Medicaid Reimbursement for Care Connectors and Coaches
  • Message for the Non-Urgent Population
• Glossary
• For More Information
• About the Speaker