By RONNIE ELLIS
CNHI News Service
At or near the top of every list of ways health care reformers see to hold down medical costs is unnecessary visits to hospital emergency rooms, usually by those on public assistance or unable to pay for the service.
In 2012 alone, Kentucky Medicaid spent more than $219 million on emergency room visits. During the same year, 4,400 of Kentucky’s Medicaid clients used the emergency 10 or more times. One went 121 times to the emergency room and another used the ER 30 separate times.
Gov. Steve Beshear announced on Wednesday that Kentucky is one of seven states chosen by the National Governors Association to work together to find ways to improve state health care and target care for such “super-utilizers” of costly medical services at ERs.
Such people often wait to seek medical attention until problems become acute — or they simply use the ER as their primary care provider.
But outside of trauma events, ER services tend to be less effective and far more costly. One of the ways Kentucky’s Medicaid Managed Care system aims to hold down growth in overall Medicaid costs is by reducing visits to ERs through more preventive care and placing Medicaid recipients with primary care providers.
On top of that, Kentucky ranks at or near the bottom of national health ratings including for such diseases as cancer, heart disease and diabetes.
Kentucky Medicaid Commissioner Larry Kissner told lawmakers in May and June that emergency room visits as well as the number of prescriptions written for Medicaid recipients have declined since the implementation of managed care.
But in announcing Kentucky’s participation in multi-state effort to provide more coordination and targeted services for super-utilizers said further reductions in the number of ER visits and costs are needed.
“Across the nation an understanding has been growing that we must focus our efforts on providing the best in coordinated care, helping to direct individuals who may be using more expensive, less effective services to more cost-efficient preventive services that provide better health outcomes in the long run,” Beshear said in a statement released by his office.
“It is by achieving these outcomes that we will build a healthier future for Kentucky,” he said.
The Developing State-Level Capacity to Support Super-Utilizers program is designed to help states create regulations, data systems, financing systems and relationships with providers and other stake holders in the delivery of high-quality, comprehensive services for those over using ER services.
The other participating states in the collaborative program are Alaska, Colorado, New Mexico, West Virginia and Wisconsin as well as Puerto Rico. Funding is provided by the Robert Wood Johnson Foundation and Atlantic Philanthropies.
They will receive assistance from the NGA staff and faculty experts, private consultants and research organizations.
“Kentucky has too long lagged behind in health rankings, and now is the time for us to begin truly moving the needle in the right direction,” said Audrey Tayse Haynes, secretary of the Cabinet for Health and Family Services which houses Medicaid.
“By participating in this national effort,’ Haynes said, “we can learn what has worked for other states and share Kentucky’s experience as well.”
RONNIE ELLIS writes for CNHI News Service and is based in Frankfort. Reach him at email@example.com. Follow CNHI News Service stories on Twitter at www.twitter.com/cnhifrankfort.