Medicaid Expansion and Avoidable Emergency Department Use—Implications for US National and State Government Spending

Sabbatini, Amber K.; Dugan, Jerome

doi:10.1001/jamanetworkopen.2022.16917

JAMA Netw Open

2022

DOI: 10.1001/jamanetworkopen.2022.16917

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Medicaid Expansion and Avoidable Emergency Department Use—Implications for US National and State Government Spending

Amber K. Sabbatini

Jerome Dugan

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2024

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Cited by 2 publications

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“…Patients receiving Medicaid disproportionately experience social risk factors for poor health and limited access to primary care 1,2 , perpetuating health disparities between them and other populations, and resulting in high utilization of emergency departments and hospitals ('acute care') for non-emergent conditions [3][4][5][6][7] . Proactive Medicaid programs attempt to contact at-risk patients-typically based on risk models trained to predict high healthcare costs 8 -and offer patients additional support to access primary care 9 .…”

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confidence: 99%

Prediction of non emergent acute care utilization and cost among patients receiving Medicaid

Patel,

Baum,

Basu

2024

Sci Rep

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Patients receiving Medicaid often experience social risk factors for poor health and limited access to primary care, leading to high utilization of emergency departments and hospitals (acute care) for non-emergent conditions. As programs proactively outreach Medicaid patients to offer primary care, they rely on risk models historically limited by poor-quality data. Following initiatives to improve data quality and collect data on social risk, we tested alternative widely-debated strategies to improve Medicaid risk models. Among a sample of 10 million patients receiving Medicaid from 26 states and Washington DC, the best-performing model tripled the probability of prospectively identifying at-risk patients versus a standard model (sensitivity 11.3% [95% CI 10.5, 12.1%] vs 3.4% [95% CI 3.0, 4.0%]), without increasing “false positives” that reduce efficiency of outreach (specificity 99.8% [95% CI 99.6, 99.9%] vs 99.5% [95% CI 99.4, 99.7%]), and with a ~ tenfold improved coefficient of determination when predicting costs (R2: 0.195–0.412 among population subgroups vs 0.022–0.050). Our best-performing model also reversed the lower sensitivity of risk prediction for Black versus White patients, a bias present in the standard cost-based model. Our results demonstrate a modeling approach to substantially improve risk prediction performance and equity for patients receiving Medicaid.

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confidence: 99%

Prediction of non emergent acute care utilization and cost among patients receiving Medicaid

Patel,

Baum,

Basu

2024

Sci Rep

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Patient-Centered Primary Care Provider Communication and Emergency Room Visits by Medicaid Patients in the United States

Platonova,

Ning,

Pan

et al. 2024

Journal of Patient Experience

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Ineffective primary care provider (PCP) communication may contribute to the overuse of emergency room (ER) care in the United States. We examined the relationship between PCP communication and ER visits within a Medicaid patient population using 2022 Health Center Patient Survey data collected by the US Health Resources and Services Administration (HRSA). Our sample was 1807 Medicaid patients who had used HRSA-funded health centers for at least 12 months. Our predictors were the Consumer Assessment of Healthcare Providers and Systems communication items. Our outcome was the number of ER visits (categorized into three levels) during the previous year. Using ordinal logistic regression, we found that patients whose PCPs always knew important information about their medical history and who always received helpful service from staff had 24% and 20% lower odds of using ER care, respectively. Patients who had seen their PCP for at least 5 years had 37% lower odds of using ER care. Effective PCP and staff communication and improved continuity of care can reduce unnecessary ER visits while improving quality and reducing healthcare cost.

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Medicaid Expansion and Avoidable Emergency Department Use—Implications for US National and State Government Spending

Cited by 2 publications

References 4 publications

Prediction of non emergent acute care utilization and cost among patients receiving Medicaid

Prediction of non emergent acute care utilization and cost among patients receiving Medicaid

Patient-Centered Primary Care Provider Communication and Emergency Room Visits by Medicaid Patients in the United States

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