Evaluation of an Intensive Care Coordination Program to Reduce Use of Hospital Emergency Department Services by Wisconsin Medicaid Members

The State of Wisconsin is now expanding its investment in care coordination models as an effort to reduce inappropriate hospital emergency department (ED) use, improve health outcomes, and reduce Medicaid expenditures. This effort begins with a pilot program to support emergency department care coordination in hospitals and health systems that apply and are selected to participate in the pilot program.

The Wisconsin Medicaid program seeks to understand whether this program achieves its intended goals and, specifically, whether the Medicaid payment for such care coordination services produces the intended program outcomes. Hospitals will select members that will receive care coordination services. In a quasi-experimental approach, the study team will compare members that do vs. do not receive the services will be used examine the effects of care coordination and referrals on total ED visits, primary-care treatable ED visits, non-emergent ED visits, and health care costs, as well as the specific effects of referring patients to providers who offer low-cost and after-hours care. To assess the importance of targeting, study team will conduct stratified analyses of vulnerable groups such as people with disabilities and individuals with specific clinical needs.