title: Washington state initiative trims Medicaid budget, ED utilization without denying access.
abstract: In its first year of operation, Washington state's "ER is for Emergencies" initiative has helped to save the state's Medicaid budget $33.6 million. The initiative, which is based on the implementation of seven best practices, has succeeded in part by improving care coordination and by linking EDs across the state so information can be shared electronically. Leaders of the effort concede that while state pressure was essential in pushing providers to address excess use of the ED for nonemergency needs, they stress that the approach worked because all sides were willing to sit down and hammer out a solution. Further, they note that the infrastructure is now in place to address other problems in a similar fashion. An analysis of claims data shows that in the first year of the initiative, ED visits by Medicaid recipients declined by 9.9%, and the rate of visits by frequent ED utilizers declined by 10.7%. The analysis also shows that ED visits resulting in a scheduled drug prescription fell by 24%, and the rate of visits for a low-acuity diagnosis declined by 14.2%. While many EDs had to adjust their staffing and other resources to accommodate reduced volumes, others experienced few changes or even saw an uptick in volume, possibly from implementation of the Affordable Care Act. Leaders of the effort say the biggest challenge involved with implementing the initiative was securing administrative buy-in for investments that would likely result in improved efficiency and care, but also reduced revenue--at least initially.
mesh_terms: D002017:Budgets; D003299:Cooperative Behavior; D017046:Cost Savings; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D055317:Evidence-Based Practice; D006300:Health Services Misuse / Q000517:prevention & control*; D006801:Humans; D008484:Medicaid / Q000191:economics*; D016730:Program Development; D013219:State Government; D014481:United States; D014861:Washington