Care Transformation Center Blog

Want to cut Medicaid ED visits? Start with ambulatory care access—here's how.

by Hamza Hasan and Clare Wirth

Editor's note: A version of this post previously ran on Practice Notes.

According to the CDC's latest data release, ED visits hit a record high in 2016. Patients covered by Medicaid and other state-based programs make up 38% of the 146 million visits across the United States—the highest of any payer type.

May 22 webconference: How to curb unnecessary ED visits

The underlying reason? Challenges accessing ambulatory care. One-quarter of adult Medicaid enrollees report using the ED because other lower-acuity sites of care are not open. Similarly, 34% of Medicaid enrollees report barriers in finding a doctor or delays in getting needed care.

Population health managers must find ways to strengthen access to ambulatory services for Medicaid patients. Here are three ways some providers are doing so:

1. Partner with existing community clinics

Depending on market dynamics, the most effective way to provide ambulatory access to Medicaid patients may be to partner with someone else in the community who already serves that population, such as a federally qualified health center (FQHC).

However, population health leaders should recognize that partnership does not simply mean diverting patients. Rather, effective partnerships include direct and indirect support for the community clinic's activities (e.g., high- value social support programs), as well as strategies to aid expansion of specialty care capabilities that community clinics often lack.

2. Establish own Medicaid-focused clinic

Diverting patients to a community-based provider may not be feasible if there isn't a good partner in the market. In that case, providers such as Catholic Health System have chosen to create their own Medicaid-focused primary care clinics.

However, because regulatory restrictions generally prevent hospitals from operating FQHCs, such clinics do not qualify for enhanced Medicaid reimbursement. So, before taking this step, health systems should carefully consider the economic realities of this investment. Many who choose to invest in Medicaid clinics do so primarily to reduce unnecessary ED costs.

3. Bolster Medicaid access across existing practices

Finally, providers will likely find that even if they use the above options, geographic realities, patient preferences, or other market-specific factors mean they are still treating at least some Medicaid patients within their existing physician practices. To ease access difficulties in doing so, some providers choose to mandate minimum Medicaid panel sizes for PCPs. Taking steps to reduce no-show rates is also particularly important for this population.

Make your patients healthy and your ED happy with community paramedicine

For organizations assuming population health risk, top priorities include reducing the rates of avoidable ED visits, avoidable admissions, and readmissions. But most organizations don't have all the staff they need to engage patients and support robust care management.

Our infographic explains how community paramedics can help extend the care team to achieve these system goals.

Download the Infographic