Colorado's key Medicaid-reform effort — matching thousands of state-supported patients to "medical homes" and careful case management — is showing promising savings, health officials will report to the legislature this fall.
More than 128,000 Medicaid clients are enrolled in seven case management regions, and preliminary data for the first six months of billing shows a 14 percent drop for inpatient hospital stays among children, state officials said.
Other categories showed lesser but still financially important drops in usage through better preventive care and weeding out duplicative services. Inpatient-hospital stays among adults with disabilities, often the kinds of complex cases that balloon costs, dropped 9 percent compared with those not enrolled in the program.
Emergency-room visits among adults dropped 5 percent in the early review.
Multiple ER visits and hospital readmissions are often a sign that patients do not have a steady primary doctor, are not taking their medications properly, or that their specialists and hospitals are not communicating enough with doctor offices on follow-up care.
Health experts say success in the reforms is critical to slowing health costs .
"This is Colorado's major Medicaid delivery system reform effort," said Laurel Karabatsos, state Medicaid director. "We're investing a lot in this program. Our analysts are feeling very positive."
Colorado launched the Medicaid reform last year, as case-loads and general health inflation drove up costs. Most health experts believe traditional health care delivery emphasizes costly procedures over coordinated patient care. Colorado's effort dovetails with national reform of paying frontline providers more to coordinate care in Medicaid and Medicare.
The reform effort ties health providers receiving a per-member fee to reaching health-outcome marks. The goal is to cut costs not by limiting care, but emphasizing preventive and follow-up care.
The state said it has not finished calculating cost savings from the usage drop, but will give a more extensive review of the program launch to the legislature in November.
"We have seen health care costs spiral upward for decades now with our siloed, disconnected delivery systems, and our fee-for-service payment mechanism," said Edie Sonn of the Center for Improving Value in Health Care, a Colorado nonprofit. "We're seeing some really good results in Colorado. We know the old model doesn't work."
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