Targeting ER Medicaid costs tricky for state



Excerpt

Under the Medical Home Network project, funded by the Comer Science and Education Foundation, six hospitals on the city’s South Side are using a real-time data-sharing network to alert health clinics when they see Medicaid patients in the ER. The clinics then telephone the patients to make follow-up appointments. The idea is to introduce the patients to a medical home and to primary care providers who can coordinate their care, improve their health and convince them to use hospitals only for true emergencies.

The project hopes to reduce the number of ER visits by half for the 170,000 patients in the network. It also aims to reduce the number of hospital admissions and readmissions for chronic problems such as asthma and diabetes.

Medical Home Network President Cheryl Lulias acknowledges that one clinic visit can cost Medicaid more than one ER visit, but she contends that the strategy of providing patients “the right care at the right time at the right place” will reduce the total cost of care by 2 percent to 4 percent per year.

“Sometimes in isolation you need to spend a little more to manage care,” Lulias said.

Because of the Medical Home Network, gospel musician Smith has started visiting Lawndale Christian clinic instead of the hospital ER. He’s hoping he’ll be able to get care for his blood pressure and asthma at the clinic, which is near his home and open six days a week.

Will it work for him? “Yes,” he said, “because I need it.”

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