Cooperating for better care.

Hennepin County

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Getting Medicaid repeaters out of the E.R.


The New York Times reports on experiments across America meant to better manage the impoverished, mentally ill and/or addicted people who drive up Medicaid and other public-health costs by frequenting hospital emergency rooms when they could be better and (often) more economically be treated elsewhere. Cambridge Management Group has been intensely working in this area of community health.

The Times reports that the Center for Healthcare Strategies  has documented such efforts in 26 states. “Some are run by private insurers and healthcare providers, while others are part of broader state overhaul efforts. The federal government is supporting some, too, through its $10 billion Innovation Center….”

“They raise a new question for the healthcare system: What is its role in tackling problems of poverty? And will addressing those problems save money?”

“We had this forehead-smacking realization that poverty has all of these expensive consequences in healthcare,” Ross Owen, a Hennepin County, Minn., health official, told The Times. “We’d pay to amputate a diabetic’s foot, but not for a warm pair of winter boots.”

”Now health systems around the nation are trying to buy the boots, metaphorically speaking. In Portland, Ore., health outreach workers help patients get driver’s licenses and give them essentials, such as bus tickets, blankets, calendars and adult diapers. In New York, medical teams are trained to handle eviction notices like medical emergencies. In Philadelphia, community health workers shop for groceries with diabetic patients.”

“The idea — to eliminate avoidable hospital use — went against years of economic habit. Hospitals make money by charging per visit and procedure, and fewer of both would dent revenues.”

So some jurisdictions, encouraged by Affordable Care Act incentives, have offered carrots.  Consider  Hennepin County {Minn.} Medical Center, which is paid a fixed amount per patient and gets  to keep the money even if patients  don’t show up, or use less medical care than was paid for.” Such pilot programs seek to care  for patients in places cheaper than hospitals — which is most places.

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