On January 16th, the Centers for Medicaid and CHIP Services (CMCS) issued an information bulletin highlighting some methods through which states may be able to reduce the non-urgent use of emergency departments (EDs) for Medicaid beneficiaries. The bulletin provides suggestions for both payment and delivery of care changes that may reduce non-emergent ED use.
The suggestions for care delivery are as follows:
1. Broaden access to primary care services through the use of medical and health homes with extended hours and the use of alternative primary care sites.
2. Focusing on 'super-utilizers' in ED's, providing this population with alternative facilities to address their care needs. The alternative models of care suggested are on-site ambulatory clinics and community intervention in health homes.
3. Targeting the needs of individuals with mental/behavioral health conditions by providing case management programs and medical homes that focus on substance use disorders.
Along with the changes to care delivery, the CMCS bulletin discusses two different payment options for states to address the high cost of over utilization of EDs. The use of cost sharing and payment variation are both options available to states, as long as states can ensure accessible and available care alternatives. The bulletin highlights a number of state programs where payment and delivery system reforms have been implemented and proven successful in reducing non-emergent ED use.
The full CIB is available here.
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