Primary Care Use Driving Down Costs, Improving Care
The Situation: In February 2013, CMS granted a waiver enabling the state of Ohio to move up to 30,000 uninsured adults in Cuyahoga County to a new health care coverage program called CarePlus by the end of 2013. Several AF4Q partners in the Better Health Greater Cleveland Alliance enrolled 28,294 uninsured patients in CarePlus, with a goal of providing better access, better care, and better outcomes, but with costs lower than those CMS estimated as “budget neutral.”
- ED use by CarePlus patients declined by at least 60 percent from 2012-2013—a decrease that was associated with a 50 percent increase in the use of primary care services during the same time period.
- Total costs of care for CarePlus patients were approximately 25 percent lower per enrollee per month than CMS’ “cost-neutral” estimates.
- Summarizing across all enrollees, MetroHealth estimates total costs of services that are approximately $50 million lower than those CMS projected.
- Diabetes process measures improved 9 percentage points (relative improvement 18 percent).
- Diabetes outcomes improved 7 points (relative improvement 28 percent).
Better Health’s President Randy Cebul, MD, believes the following conditions contributed greatly to the effort’s better-than-expected results:
- All sites participating in CarePlus were in EMR-facilitated safety net organizations with longstanding commitments to disadvantaged populations and having highest-level national recognition for patient-centered care.
- Patients were recruited and supported by nurse care coordinators partly funded by CMS.
- MetroHealth—Ohio’s largest safety net provider—assumed some financial risk if it exceeded the CMS cost-neutrality requirements and thus had a strong financial incentive for improvements in quality.
According to Better Health’s Data Center Director Thomas Love, PhD, “The year-to-year improvements for diabetes patients are unprecedented in Better Health’s history of public reporting. They are especially remarkable because the Care Plus patients were only enrolled for an average of nine months in 2013 and were more disadvantaged than other uninsured patients in 2012.”