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In Ohio, More People Have Insurance. Now What?

by Caroline Smart, CloudView Editor

Welcome back to Population Health(ier), a recurring series featuring athenahealth and The Atlantic's best storytelling on America’s population health revolution. To catch up on our series, you can find last week’s story here. Today, we explore how University Hospitals in Cleveland is activating Ohio's newly insured patients.

Ohio’s uninsured rate has been slashed in half since 2012, the Ohio Department of Medicaid disclosed in a recent statewide survey, with massive enrollment following the passage of the Affordable Care Act. The survey, called the Ohio Medicaid Assessment, found that the rate of Ohioans without insurance dropped from 17.3 percent in 2012 to 8.7 percent this year.

University Hospitals was among the most active advocates for the expansion of Medicaid at the state level, which drew $2.5 billion in extra funds from the federal government to provide coverage for 275,000 eligible Ohioans.

But the sudden and sweeping expansion in insurance coverage has also posed several structural challenges: Many of the newly insured simply don’t know where to turn for care, with most coming to the emergency department. Visits to the emergency room are very costly to the system. The average cost of an ER visit for more than 8,000 patients across the U.S. was $2,168, according to a 2013 Time Magazine investigation.

In devising ways to tackle the problem, UH struck on an innovative plan heralded by the hospital’s emergency department: It developed what is known as a medical-access clinic, an area just outside the ER.  There, patients receive urgent care services, get information about benefits, and schedule follow-up appointments with a primary care physician.

University Hospitals is also working through its Accountable Care Organization (ACO) to reach out to patients proactively. Face-to-face encounters in the community are performed by so-called patient navigators—qualified healthcare professionals who help patients navigate the health system and eliminate barriers to treatment.

Other noticeable improvements resulting from Ohio's Medicaid expansion have occurred in behavioral health. UH has helped Ohio Medicaid recipients understand their mental health benefits, and the importance of medication compliance.

Overall, increased Medicaid coverage has improved population health management, allowing UH to help patients manage their health “upstream,” while they’re still well. The work of UHACO now ensures that healthcare delivery is performed under a single, streamlined system, which is better able to manage preventive care. This makes both medical and financial sense. “There’s no question about it,” Dr. William Steiner, interim president and medical director of UHACO, said. “Better information and better coordination leads to reduced costs.”

There is still lots of potential for improvement in coverage. A new study by the nonprofit Kaiser Family Foundation shows that almost 70 percent of Ohio’s uninsured residents who are eligible to receive Medicaid coverage or subsidized insurance have yet to sign up. As the next open-enrollment period comes to a close on December 15, 2016, healthcare advocates are hoping to see an even greater uptick in coverage than before. As Dr. Michael Anderson, chief medical officer at UH Cleveland Medical Center, puts it: “The more financial stability a busy delivery system like this has, the more positive things it can bring into the community.”   

Caroline Smart is a Senior PR Associate and CloudView Editor.

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