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Blue Cross Blue Shield MIH-CP Program Cuts ER Visits, Saves Medicaid Dollars

06/02/2017

May 30--It's well established that the most expensive health care is delivered in an emergency room. So it stands to reason that anyone visiting an emergency room who could be treated just as effectively, and possibly more quickly, in an urgent care center or in their doctor's office is wasting money. If they're a Medicaid patient, they're wasting everyone's money.

That realization prompted a private health insurer, Blue Cross Blue Shield of New Mexico, to start a pilot program that has paramedics making house calls to recently discharged Medicaid patients to check on their health and reduce hospital readmissions. The program also has nurses visiting patients scheduled for hospital discharge who may be at high risk for readmission, including those with chronic illnesses or who are recovering from surgery.

In its first year, the Community Paramedicine initiative has assisted more than 1,100 Medicaid patients in the Albuquerque area, reduced emergency room visits by nearly 62 percent, decreased ambulance use by 63 percent and saved the insurer about $1.7 million. That saves taxpayers money, and it saves time for everyone else waiting to be seen in the ER. No wonder BCBS wants to expand it to other parts of the state.

The program perhaps most importantly safeguards the health of some of our most vulnerable citizens. It focuses on "super utilizers," patients who use 911 or visit hospital emergency rooms four or five times a year. Those patients typically live alone, have a limited support network, lack transportation or have an unsteady housing situation.

Paramedic Shelley Kleinfeld says she visits 10 to 12 patients a week to check their vital signs, help them manage their medications and medical equipment, coordinate doctor's appointments and check if there is enough food in the house. "It's nice to interact with someone other than from the back of an ambulance," she says.

While it's easy to be skeptical of so-called "win-win" situations, this program seems to fit the bill. Kudos to BCBS and the dedicated paramedics and nurses who make the program work.

This editorial first appeared in the Albuquerque Journal. It was written by members of the editorial board and is unsigned as it represents the opinion of the newspaper rather than the writers.