Kentucky Taps HIE Data To Identify, Address Medicaid ED Super Users

April 24, 2014 in News

Kentucky officials are leveraging the state’s health information exchange to identify and address emergency department “super utilizers,” Clinical Innovation Technology reports (Pedulli, Clinical Innovation Technology, 4/23).

Background

Like many states, Kentucky has struggled with spending a disproportionate amount of money on a small group of patients who frequently visit the ED (Sarkar, GCN, 4/22).

According to Clinical Innovation Technology, 350,000 Kentucky Medicaid beneficiaries visited EDs at a cost of $341 million over one year (Clinical Innovation Technology, 4/23).

About 4,400 state Medicaid beneficiaries visited EDs 10 or more times over the one-year period, at a cost of $34 million.

In addition, state officials found that one Medicaid beneficiary visited the ED 121 times, while another visited 30 EDs in different locations.

Details of the Initiative

Last year, under a directive from Gov. Steve Beshear (D), state officials launched an initiative with the state’s Medicaid program and the Kentucky Health Information Exchange that aims to identify ED super users and provide them with more coordinated care in an effort to reduce disproportionate Medicaid spending.

For the initiative, state officials selected 16 hospitals — including both small and large facilities in urban and rural areas — that were connected to KHIE (GCN, 4/22).

Officials then installed an alert system within the state HIE that notifies health care providers and coordinated care teams when a super user enters a health care facility. The coordinated care teams are responsible for reaching out to the patient to discuss his or her issues and provide appropriate treatment (Clinical Innovation Technology, 4/23).

Comments

Polly Mullins-Bentley, executive director of the Kentucky Governor’s Office of Health Electronic Information, said the initiative’s “objective … is to steer this patient, this super utilizer, away from the emergency department to a better place to receive primary care, which would be a patient-centered medical home, primary care provider or it might be the local health department.”

However, John Langefeld, chief medical officer for the Kentucky Department for Medicaid Services, said it is still too early to tell if the initiative is helping to address the issue. He said he hopes the program will one day be able to send secure, real-time alerts to providers and coordination teams when a super-utilizer enters their facility (GCN, 4/22).

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