HJAR Jul/Aug 2019

50 JUL / AUG 2019 I  Healthcare Journal of ARKANSAS column medicaid Emergency services have long been the focus of studies regarding effective delivery of healthcare. While timely access to care is important, overuse of the emergency room (ER) can result in expensive, fragmented care for patients who could be better served by the outpatient sector. New data from Arkansas Medicaid shows the prudence of using care alternatives in ambulatory settings rather than ERs. Use of emergencyrooms by Medicaid beneficiaries raises important issues about appropriate service utilization. One of the largest issues is cost. While commercially insured patients face significant co-pays for using emergency rooms, Medicaid patients have no out-of-pocket fees and can have benefit incentives to using the ER for basic healthcare. To combat this issue in 2014, Arkansas Medicaid launched the Patient Centered Medical Home (PCMH) program to make ac- cess in the ambulatory setting more respon- sive. For example, all PCMH clinic sites are now required to give patients 24/7 live voice access to health professionals. ER visits could be reduced because patients do not encoun- ter answering machines when they seek ad- vice on weekends and evenings. In addition, Arkansas Medicaid has long paid for triage reviews so patients coming to the ER with minor ailments can be re-routed to primary care sites during office hours. Acomparison of ER visits per thousand Medicaid patients nationwide found Arkansas has lower rates of utilization than surrounding states. Arkansas Medicaid recently redesigned its data analytic reporting of ER visits. The program launched a new semi-annual report in which all acute care hospitals supply in- formation regarding their populations served and conditions seen in comparison to other facilities inArkansas. Arkansas Medicaid has also repurposed this data to provide informa- tion to PCMHs regarding their patient panels and how their patients are using acute care services. This report allows the Medicaid pro- gram to understand state-wide utilization Using Care Alternatives to Emergency Rooms