Q&A: How Ohio Reduces Avoidable ER Visits by Medicaid Beneficiaries

Thursday, November 10th, 2011
This post was written by Jessica Fornarotto

An Ohio collaborative of Medicaid plans uses a rapid cycle quality improvement approach to reduce avoidable ER visits by its Medicaid population. In an interview prior to her presentation on Reducing Avoidable ER Visits by Medicaid Patients Through Quality-Based Interventions, Mina Chang, PH.D., provided details on the effort. Dr. Chang works for the Bureau of Health Services Research for the Ohio Department of Job & Family Services.

HIN: Why were these particular regions of Ohio chosen for the study?

(Dr. Mina Chang): The reason we focused on urban centers is that that’s where the hospital system is located. It’s high volume. We work with each of the regions and with about 30-40 healthcare leaders. It’s a local driven initiative. This group of participants would help us identify key populations that are unique, or a priority population that potentially can benefit from reducing avoidable visits. This group would also help Ohio Medicaid develop and test prevention or quality interventions that are meaningful for those populations that would be identified.

HIN: One of the five regions in the collaborative is Toledo, Ohio, which has the highest emergency department utilization in the nation. What methodology is used to reverse this trend?

(Dr. Mina Chang): We follow a methodology developed by the Institute for Health Care Improvement. It’s population-based and patient-centered. What is attractive about this methodology is that it adopted a rapid cycle, quality improvement approach that typically is focused on a very small subset of a population. With this methodology, you develop a quality improvement strategy and test it out until something is found to be effective. Then, you can in turn extend it to a larger population. It’s very different from a traditional research approach, where as you have to wait four to five years to find out that your investment has not worked.

HIN: How did you identify the priority populations for these interventions?

(Dr. Mina Chang): State Medicaid data has confirmed with what our practitioners see day in and day out in their practice. Medicaid populations predominantly are children. Many high-utilizers are upper respiratory tract infections and otitis media types of issues.

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