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Medicaid members connect with primary care
By using a combination of education and case management, Molina Healthcare of Michigan has decreased the number of members who frequently visit the emergency department with primary care issues.
"We began this initiative after we determined that our emergency department rates were very high and that some of our members were going to the emergency department over and over for problems that could be handled in a primary care setting," says Janet Marino , RN, MSN, CCM, director of utilization management.
Molina Health Care of Michigan is part of a national managed care organization that provides coverage for Medicaid and Medicare members. In Michigan, the HMO has about 210,000 Medicaid members and about 1,300 Medicare members.
The health plan mines claims data each month and identifies frequent users for the emergency room case management program.
Anyone who has visited the emergency department three or more times in a month receives an educational package.
Educating patients
The packet includes information explaining Molina's health care benefits, including the name of the member's primary care provider; a list of urgent care providers; a phone number patients can call to access behavioral medicine services; and the health plan's nurse advice line number.
The letter emphasizes the importance of seeing a primary care physician, reminds the member that Molina provides transportation to their doctors' appointments, and includes the transportation number.
Many times, the emergency department visits are the result...