Kentucky is one of six states along with Puerto Rico that will participate in a program to help drive down medical costs by targeting frequent healthcare system users.
The National Governors Association introduced the Developing State-Level Capacity to Support Super-Utilizers policy academy to help train officials from participating states to develop plans that can serve as policy drivers, but which may also serve patients who could benefit from less costly, more appropriate treatment.
The commonwealth will focus on frequent emergency room users, says Dr. Stephanie Mayfield, commissioner of Kentucky’s Department of Public Health.
Last year, over 4,000 Medicaid patients used the ER 10 times or more, according to state officials. That means the state’s Medicaid system spent over $200 million last year on ER visits alone.
“What we’re hoping the plan will be is that emergency rooms are there strictly to be used as emergency rooms and that we develop a plan so that they’re not de facto primary care centers any longer,” says Mayfield.
Details of the Kentucky plan have not yet been laid out, but officials say it could include new data systems, workforce, or financing structures.
Mayfield says there are already models for certain ideas that exist around the state, and the Kentucky team already met this week to review what’s currently available.
The Louisville Metro EMS implemented its PSIAM system a couple years ago, which places nurses next to 9-1-1 operators. When the program and operator decide the call is of lower-acuity, the call will be passed to a PSIAM trained nurse who will help redirect the caller to more appropriate care.
Officials say they have been able to direct over 30 percent of 9-1-1 callers who spoke with a PSIAM triage nurse to non-emergency department care, which can be the most costly care patients can receive.
The Kentucky team consists of Dr. Mayfield, the state’s Medicaid director, and representatives from University of Kentucky, University of Louisville and Pikeville University.
The program will run for a year and begins in August. It’s paid for by the NGA.