Kids health care program cuts ER visits

GRAND RAPIDS, Mich. (WOOD) - A program giving Kent County children on Medicaid access to regular visits with pediatricians has resulted in a 6 percent decline in emergency room usage and unnecessary hospital visits among participants, program creators announced this week.

The Children's Healthcare Access Program, developed by First Steps in partnership with Priority Health, Helen DeVos Children's Hospital, Cherry Street Health Services and others, gave 1,000 children on Medicaid access to a primary care doctor. Several visits to a doctor's office are less expensive than a single emergency room visit, industry observers note.

"I don't think we expected a particular amount" of decline in the number of ER visits and unnecessary hospital stays, said Maureen Kirkwood, manager of the Children's Healthcare Access Program. "I think we're pleased with any change. It certainly translates into some cost savings."

The 6 percent drop among program participants since August 2008 stands in stark contrast to overall emergency room visits in Kent County during that period, Kirkwood said.

Spending less on emergency room visits for children on Medicaid could result in savings for taxpayers down the line, but there is an immediate benefit to health care consumers: the costs of treatment beyond what Medicaid will cover is no longer shifted to other patients.

Key to the creation of 1,000 new patient spots among pediatricians was Priority's promise to increase Medicaid reimbursements to private physicians by 60 percent. Doctors, who might typically be paid $30 by Medicaid for an office visit costing $50 to $60, often are reluctant to take on new Medicaid patients.

As Priority calculates how much it has saved due to the 6 percent cut in ER visits, it will have to take those costs into consideration.

The insurer already has signed on for another year of the pilot program.

"We have commitment from Priority Health, from our funders to fund the staff that provide transportation and home visits and the supportive services to the patients -- and we have our practices (doctor's offices) on board for year two as well," Kirkwood told 24 Hour News 8.

Still, the program manager acknowledges giving 1,000 children access to a pediatrician -- and providing home health education, asthma education and free transportation to another 2,000 families -- falls far short of demand: 35 percent of children in Kent County are on Medicaid.

'We are now looking at expanding in year two, so we are having conversations with other Medicaid health plans here in Kent County," Kirkwood said. "There's a great deal of interest from the state perspective in our model. There are other parts of the state that want to replicate what we're doing ... We're very pleased."