Guest Column: Provider Care Coordination Shows “Tremendous Potential” in Reducing ED Use (Joe Sanfelippo)

By Rep. Joe Sanfelippo (R-New Berlin)

February 23, 2018

The biggest challenge in health care today is balancing how to provide patients with access to the highest quality of care possible against the costs associated with providing that care. That’s why addressing gross inefficiencies in health care is of paramount importance. One of the most glaring issues is that of “high utilizers.” These are patients who repeatedly end up visiting emergency departments for care. Nationally, around five percent of patients account for about a quarter of all emergency department (ED) visits annually. According to the Wisconsin Hospital Association, over 10,000 Medicaid patients in Wisconsin visited an ED seven or more times in 2016. That represents roughly 111,000 ED visits. Over 3,000 patients in the state ended up in an ED seven or more times in both 2015 and 2016. All told, these repeated visits cost the Wisconsin Medicaid program over $52 million annually. These are staggering numbers; yet, they represent a massive opportunity for improvement.

That’s why Representative Jessie Rodriguez, Senator Alberta Darling, and I have introduced Assembly Bill (AB) 871, which passed the Assembly this week with unanimous support. In talking to hospitals and health systems throughout Wisconsin about the high utilizer problem, we’ve learned about the tremendous potential that care coordination has for significantly reducing the repeated use of emergency rooms by Medicaid recipients. The problem stems from the fact that many of these patients are visiting the ED for non-emergent reasons and they are, essentially, using the ED in lieu of primary care. No one wants to discourage people from seeking care in an actual emergency, but many high utilizers are individuals who go to the ED when they really should be seeing their general practitioner.

The Milwaukee Health Care Partnership analyzed this trend and found that 47 percent of ED visits were for non-emergent issues. Many of these patients either don’t know how to access health care more appropriately or simply can’t, for a wide variety of reasons. In many cases, it can be as simple as the patient either not knowing that they should be going to their primary care physician for these issues or not being able to get to their doctor during business hours. Other challenges these patients face often relate to basic socio-economic factors like unemployment, family obligations, and access to housing or transportation. If emergency departments had the resources and incentives to follow up with these patients and help them resolve their issues, we could solve the problem of overutilization by actually addressing the underlying causes, and that’s exactly where care coordination comes in.

We’ve seen impressive results from care coordination programs here in Wisconsin. Aurora’s pilot program saw a 44 percent reduction in ED visits after six months, and a staggering 77 percent reduction after 12 months. Ascension St. Joseph’s program reduced ED visits by 5,000 encounters. Through simple, but impactful, assistance like scheduling and maintaining primary care appointments, providing transportation, or arranging child care, these patients are able to get the care that they really need. These promising results are why AB 871 attempts to implement a larger Medicaid pilot program for care coordination statewide in order to see how well these results scale. By providing hospitals and health care systems with financial incentives to follow-up with high utilization patients, Wisconsin can realize massive cost savings while, simultaneously, improving the quality of care that this vulnerable population of patients receives.

Representative Joe Sanfelippo (R-New Berlin) is Chairman of the Assembly Committee on Health and a lead author of Assembly Bill 871.

This story originally appeared in the February 23, 2018 edition of WHA Newsletter