Policy: Entitlements

Report: Fewer ER visits for Ore. Medicaid patients

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News,Business,Oregon,Medicare and Medicaid,Entitlements

SALEM, Ore. (AP) — People on the Oregon Health Plan are making fewer visits to the emergency room and more visits to primary care clinics, according to a new report on Oregon's year-old coordinated care organizations.

The Oregon Health Authority says the report shows Gov. John Kitzhaber's overhaul of the state Medicaid program is achieving its goals in reducing unnecessary use of the emergency room.

However, the figures don't allow for a definitive conclusion about whether the coordinated care organizations are responsible for the shifts. The report looked only at Medicaid patients, so it's unclear if the results were substantially better than other segments of the health care market.

Oregon Health Plan members made 13 percent fewer ER visits in the first nine months of 2013 when compared with 2011. Every CCO saw a reduction, although the level varied widely. Hospitalizations for chronic conditions also dropped, by 32 percent for heart failure, 46 percent for chronic obstructive pulmonary disease and 18 percent for adult asthma.

The number of primary care visits jumped 16 percent in the year after CCOs launched.

Kitzhaber persuaded Oregon lawmakers to create coordinated care organizations to oversee physical health, mental health and dental care for patients in their area. The Obama administration gave Oregon nearly $2 billion over five years to keep the Medicaid system afloat while the CCOs ramp up their operations. In exchange, the state has promised to save at least as much money over the following five years.

The 16 coordinated care organizations have improved flexibility to care for patients but must stick within strict funding limits. Proponents hope the combination of more flexibility and limited funding will encourage the CCOs to find new ways to reduce avoidable hospital visits. Some are hiring case workers to actively ensure patients are following treatment plans or to intervene with patients who frequently visit emergency rooms.

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