Fewer ER visits for Ore. Medicaid patients, report shows

SALEM, Ore. — 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.

But 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 coordinated care organization 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 coordinated care organizations 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 coordinated care organizations 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 more flexibility to care for patients, but they must stick within strict funding limits. Proponents hope the combination of more flexibility and limited funding will encourage the coordinated care organizations 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.

The report looked at the use of ERs by Medicaid patients before and after the coordinated care organizations were created.

A study published last month found that patients newly covered under Oregon’s Medicaid program made 40 percent more emergency room visits in the first two years compared with others who didn’t gain coverage. The study by researchers at Harvard University, the Massachusetts Institute of Technology and elsewhere looked at a period before Oregon created coordinated care organizations.

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