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

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.