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Emergency Department Use in California, Event Briefing

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object(Timber\Post)#3742 (44) { ["ImageClass"]=> string(12) "Timber\Image" ["PostClass"]=> string(11) "Timber\Post" ["TermClass"]=> string(11) "Timber\Term" ["object_type"]=> string(4) "post" ["custom"]=> array(5) { ["_wp_attached_file"]=> string(44) "eventbriefing_emergencydepartmentuse0419.pdf" ["wpmf_size"]=> string(6) "353079" ["wpmf_filetype"]=> string(3) "pdf" ["wpmf_order"]=> string(1) "0" ["searchwp_content"]=> string(2952) "Emergency Department Use in California April 15, 2019 Shannon McConville Hospital emergency departments (EDs) are a vital component of California’s health care system  EDs provide necessary medical care to all  ED use is a focus of policymakers, payers, and providers – High cost relative to other settings – Serves as proxy for lack of access to primary care – Policy responses often focus on avoidable visits and “frequent flyers”  ACA coverage expansions have raised questions about ED use – Medi-Cal beneficiaries have high ED usage rates 2 ED use has increased over the past decade 16,000,000 40 14,000,000 35 12,000,000 30 10,000,000 25 8,000,000 20 6,000,000 15 4,000,000 10 2,000,000 5 00 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Admission ED visits Outpatient ED visits Total ED visits per 100 population 3 Outpatient ED use increased across all groups Outpatient ED visits per 100 population 45 40 35 30 25 20 15 10 5 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Female, 19–34 Senior, 65 and older Female, 35–64 Child, under 19 Male, 19–34 Male, 35–64 4 Many never visit an ED—others make a disproportionate share of visits Distribution of ED visits by frequency of ED use, adults under age 65, 2016 100% 80% 60% 40% 1.1% 1.9% 6.8% 25.6% 65% 10.7% 7.8% 16.5% 30.9% More than 10 Visits 7-10 Visits 4-6 Visits 2-3 Visits 1 Visit 20% 34% 0% % Patients % Visits 5 Medi-Cal now covers half of outpatient ED visits for adults under 65 Share of ED visits by coverage source Payer source for outpatient ED visits made by non-elderly adults, 2005–2016 0.6 0.5 Private Medicaid 0.4 Uninsured 0.3 Other 0.2 0.1 0 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 6 Did the ACA coverage expansions contribute to increasing ED use?  Trends of increasing ED use pre-date the ACA  We find no evidence that ACA coverage expansions contributed to increased ED use  Analysis of all 58 counties suggests ED use would have been higher if not for the ACA coverage expansions – Counties most affected by coverage expansions saw less of an increase in ED visits than would be expected 7 Looking forward  Continued growth in ED use raises concerns  Medi-Cal program and managed care plans play a key role in slowing the upward trend in ED use  Policy initiatives focus on heavy users, addressing behavioral health and other social factors – Whole Person Care Pilots – Health homes – Drug Medi-Cal redesign and behavioral health integration efforts 8 Emergency Department Use in California April 15, 2019 Shannon McConville Notes on the use of these slides These slides were created to accompany a presentation. They do not include full documentation of sources, data samples, methods, and interpretations. To avoid misinterpretations, please contact: Shannon McConville (mcconville@ppic.org; 415-291-4481) Thank you for your interest in this work. 10" } ["___content":protected]=> string(180) "

Emergency Department Use in California, Event Briefing

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