CHP: NYS Medicaid Emergency Care Costs Drop

Medicaid Emergency Care Costs DropCrain's Health Pulse April 25, 2013

For years, health policy analysts have predicted that if patients had better access to primary care, they would make fewer visits to hospital emergency rooms. To the satisfaction of the Cuomo administration, using that strategy in redesigning care for the state's Medicaid patients appears to be working.

According to a state Department of Health analysis of Medicaid expenditures for April 2012 through February 2013, the state spent $32 million less on emergency room care than it had projected based on the prior year's spending. The total for the period was $452 million, compared with the $484 million projected.

"Managed care is having a real impact," a DOH spokesman said.

That includes moving patients into patient-centered medical homes, where patients with chronic conditions like diabetes or asthma are more carefully monitored. As of February, 75% of Medicaid patients in the state were in managed care plans, or 10.5% more than in March 2012.

"The most recent data supports our goal to provide appropriate care more effectively, which benefits patients and helps contain or reduce costs," the spokesman said.

The drop in Medicaid patients' ED visits was seen in every region of the state. In New York, emergency department spending dropped to $290 million for the period April 2012 to February 2013, from $364 million for the year-earlier period.

In addition, the average claim paid was less costly, at about $499 versus $565. On Long Island, ED spending for that period dropped to $22 million from $29 million and claim cost on average was $424, down from $464 for that period in the prior fiscal year.