Online Program

An academic-public health case study of Medicaid ER use: Interventions and policy strategies

Tuesday, November 5, 2013 : 9:30 a.m. - 9:50 a.m.

Bethany Hall-Long, PhD, RNC, FAAN, School of Nursing, University of Delaware, Newark, DE
Suzanne Milbourne, PhD, College of Health Sciences, University of Delaware, Newark, DE
Gregory Dominick, PhD, Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE
Mia Papas, PhD, Value Institute, Christiana Care Health Systems, Newark, DE
Ingrid Hansen, School of Nursing, University of Delaware, Newark, DE
The purpose of this abstract is to vividly present replicable, evidenced-based interventions and public policy insights for public health nurses, working with disparate indigent clients, based upon the lessons from an academic-public health case study of Medicaid clients use of Emergency Department (ED) care in Delaware. National attention has been given to tackling Medicaid client's health conditions and measures to decrease their unsanctioned use of EDs as compared to privately insured individuals. Given that the "Affordable Care Act" will expand the Medicaid population, public health nurses should be equipped with cutting edge and evidenced based intervention skills. A purposive sample of health care professionals' (n=76) were interviewed to ascertain views of high ED use among the DE Medicaid population. In turn, a secondary data analysis of over several million Medicaid Managed Care Organizations claims data (2008-2012) occurred with GIS mapping (i.e., client & primary care census block locations, ICD-9 codes, etc. ) Triangulation of the data resulted in findings that support a dynamic approach to considering interventions to reduce unsanctioned emergent care and improve health among Medicaid clients. In contrast to ‘patient-condition' interventions, research findings support that a broader, cross-sector collaboration is necessary to identify both patient and environmental ‘conditions' vital for planning interventions. Specifically, findings of this study suggest four target groups and eight intervention types that are applicable not only at the local and national levels, but have global implications for indigent populations. Implications for state level health policy, public health nursing, social justice, and academia are shared.

Learning Areas:

Administer health education strategies, interventions and programs
Public health or related nursing
Public health or related public policy
Public health or related research

Learning Objectives:
Discuss 2-3 social, clinical, and policy driving forces public health nurses must address to tackle frequent Emergency Department (ED) use by Medicaid Clients. Identify possible academic and public health based data sets, methods, and measures to intervene with indigent and Medicaid clients, who use the ED. Describe 3-4 evidenced based/translational research measures public health nurses can apply for clinical interventions and public policy strategies with Medicaid frequent Emergency Department(ED) Users. Compare local, state, and global evidenced based public health political strategies nurses can apply in academia, for workforce development and in clinical practice.

Keyword(s): Emergency Department/Room, Medicaid

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been a public health nursing faculty for over two decades and have been the PI for multiple federal (i.e. NIH, HRSA etc.) and private funded public health studies. I serve as the PI for the study to be presented on ER Medicaid Use in DE. I also serve as an elected DE State Senator and Chair of the DE Senate's Health Committee and have an interest in public health issues.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.