Emergency Department Use in California, Event Briefing
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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"
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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"
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