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A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
06:59

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Published on: November 9, 2016

Emergency department use by adult medicaid patients after implementation of managed care

R D Powers1

  • 1University of Connecticut School of Medicine, Farmington, CT, USA. rpowers@harthosp.org

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
|December 2, 2000
PubMed
Abstract

Insights

Mandatory Medicaid managed care (MMC) significantly reduced emergency department (ED) visits among adult Medicaid patients. This decline was most notable for low-acuity conditions, indicating a shift in care-seeking behaviors.

Area of Science:

  • Health Services Research
  • Public Health Policy
  • Emergency Medicine

Background:

  • Medicaid managed care (MMC) programs aim to control costs and improve care coordination for Medicaid beneficiaries.
  • The impact of mandatory MMC on emergency department (ED) utilization among vulnerable populations remains a critical area of study.

Purpose of the Study:

  • To evaluate the effect of mandatory Medicaid managed care (MMC) implementation on emergency department (ED) utilization patterns for adult Medicaid patients.
  • To assess changes in ED visits before and after the mandatory MMC program at an urban teaching hospital.

Main Methods:

  • Retrospective cohort study design utilizing four years of ED patient records.
  • Analysis of ED utilization data from the year preceding MMC initiation, the enrollment year, and two years post-program maturation (1994-1998).

Main Results:

  • A steady decline in ED visits by MMC patients was observed, reaching a 40% reduction by 1998 compared to pre-MMC levels.
  • Visits for acute illness/injury decreased by 29%, while low-acuity visits dropped by 43%.
  • After-hours/weekend low-acuity visits saw a 19% decline, subsequently stabilizing.

Conclusions:

  • Mandatory managed care is associated with a substantial decrease in ED utilization by Medicaid patients.
  • The reduction in ED use is most pronounced for low-acuity conditions, with less impact on after-hours and weekend visits.

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