OSU Study Suggests Oregon Medicaid System Is Cutting Needless Hospital Visits

Oregon’s Medicaid program is helping to cut expensive unscheduled trips to the hospital by low-income, government-insured patients, an Oregon State University study says.

The researchers studied the files of more than 86,000 Medicaid-eligible women ages 15-44 from 2011 to 2013 looking at total hospital admissions, scheduled, unscheduled and preventable, OSU said. During that period, preventable hospital admissions in the group declined, the study found. That suggests Oregon’s system of coordinated care organizations administering Medicaid is working, the study said.

The CCO system emphasizes primary care, and tries, among other things, to reduce unnecessary patient use of hospital emergency rooms. A single emergency room visit by a Medicaid patient can cost the government several thousand dollars, even though the same treatment could have been provided to the patient at a primary care clinic for several hundred dollars.

Here’s OSU’s news release:

Coordinated care model leads to decreases in unscheduled, preventable hospitalizations

OREGON STATE UNIVERSITY

CORVALLIS, Ore. - Oregon Medicaid enrollees are less likely to make unscheduled trips to the hospital following the implementation of the state's accountable-care model, new research by Oregon State University shows.

The study suggests the Oregon system of coordinated care organizations, or CCOs, which have been serving Medicaid enrollees since 2012, can provide lessons to other states regarding the three-pronged pursuit of better health, better care and lower cost.

Health economist and health policy researcher Jangho Yoon of the OSU College of Public Health and Human Sciences led the study.

Among all types of patients, privately and publicly insured as well as the uninsured, hospitalizations account for nearly one-third of U.S. health expenditures, so reducing them in ways that don't compromise care is an important goal.

"Between 2003 and 2009, elective hospital admissions remained stable, but non-elective admissions grew from 25.3 million to 26.7 million," Yoon said. "And hospitals' emergency departments have become the primary gateway to inpatient care."

Oregon's 15 CCOs emphasize primary care, disease prevention and population health measurements, not just individual outcomes. They work with Medicaid patients under a lump sum payment system that rewards the CCOs for hitting certain quality standards, including efficient use of hospital emergency rooms.

Oregon is one of 13 states with an accountable-care system for Medicaid patients and is considered to have implemented the most progressive model of accountable care.

Yoon and collaborators from the College of Public Health and Human Sciences analyzed Oregon Medicaid eligibility files from 2011 to 2013 for more than 86,000 women ages 15-44, looking at total hospital admissions: scheduled, unscheduled and preventable.

Scheduled admissions refer to hospitalizations for reasons that are elective. Unscheduled admissions are all non-elective hospitalizations, including transfers from other hospitals, direct admissions from outpatient providers and admissions through an emergency room. A preventable admission is one that arises from a condition that, if managed properly, could have been avoided or treated without hospitalization.

"The accountable-care model implemented for Oregon Medicaid enrollees led to a decrease in preventable hospital admissions in the study group," Yoon said. "That suggests the Oregon model, which emphasizes primary care and care coordination aligned with strong financial incentives on provider care coordination, may promote more efficient use of resources in the health care system."

Collaborating with Yoon were Lisa Oakley, Jeff Luck and S. Marie Harvey.

The Centers for Disease Control supported this research, and findings were published in the American Journal of Managed Care. The journal's editors double-checked all of the numbers in the paper, Yoon said, and also collaborated with the researchers on terminology.

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