Journal Record: Initiative seeks to cut waste from Medicaid system

TULSA – Dr. David Kendrick is working to cut waste out of the Medicaid system by using an information highway.

The physician and CEO of MyHealth Access Network is coordinating a group of health care providers and community workers to find out what social factors stand in the way of some Oklahomans getting healthier. His company won a $4.5 million, five-year federal grant to coordinate social and health services for 375,000 people. The Oklahoma City-County Health Department’s and the Tulsa Health Department’s staffs are participating in the initiative.

The project is part of the U.S. Centers for Medicare and Medicaid Services’ accountable health communities initiative. The nationwide project aims to determine what barriers Medicaid recipients face and how health care providers can prevent patients from seeking costly and duplicate services, particularly in the emergency department.

Kendrick has to ensure his patients get better, like most physicians who accept Medicaid. If he can’t demonstrate that improvement, his reimbursement rate gets cut by 4 percent.

The health departments will screen 75,000 Medicaid recipients annually, asking people about whether they are hungry and have access to healthy food, have safe housing, experience domestic violence, have transportation, and can afford utilities to keep their homes warm in the winter and cool in the summer. Those factors, known as social health determinants, make a significant difference in improving an individual’s health.

“If I can’t get their blood pressure controlled, is it because they don’t have enough food to eat?” Kendrick said.

His company runs the only remaining health information exchange in Oklahoma. The network shares patient medical records among doctors, nurses, pharmacists and even paramedics. Sharing those records can show an emergency room physician what medications a patient has been prescribed and one’s treatment history.

Kendrick’s service also provides alerts to physicians so they are updated when one of their patients visits an emergency room, prompting a follow-up call to the patient.

There are already 180 physicians in the MyHealth network who screen patients for social health determinants in Oklahoma. The health departments will help physicians by conducting the screenings and adding more patients to the community health model, Kendrick said.

Jackie Shawnee, government affairs liaison for the Oklahoma City-County Health Department, said her organization will train community members to become navigators or caseworkers as part of the grant initiative. Those people will connect patients with social services and follow up to ensure patients get what they need.

A pilot project suggests Kendrick’s initiative will be successful. The Oklahoma City-County Health Department partnered with two local hospitals using similar screening and assistance methods. Community health workers were paired with patients who used the emergency department as a replacement of primary care.

Those workers helped direct patients to community clinics, which lowered uncompensated care costs all hospitals face, Shawnee said. The project included 120 people and saved nearly $480,000 in one year, according to a financial analysis for patients enrolled from August 2015 through July 2016. There was a 56.5-percent reduction in direct emergency department costs. By February, 64 percent of the participants had a primary care provider.

National research showed that if all physicians in the country used health information exchanges, duplicate tests could be eliminated and save the Medicaid system $63 million annually, according to a 2016 Brookings Institution Study.

Shawnee said community health navigators must close the loop to ensure Medicaid recipients get the social services they need to improve their overall health. The MyHealth network will track how those navigators connect patients with resources.

“We’re not just educating people, we’re taking them by the hand,” Shawnee said. “That is required for the grant is (community health workers) to manage those clients all the way through.”

Tulsa Health Department Executive Director Bruce Dart said the grant helps address underlying cultural issues that affect community health. If his staff gets a more holistic perspective on what keeps people sick, the employees can provide a well-rounded approach at improving health.

“It’s so much cheaper to prevent these issues than to treat them once they start,” Dart said. “The more critical the health issues are, the more expensive they are.”

A woman with her baby speaks to nurse Lynnda Parker at the Oklahoma City-County Health Department at 2600 NE 63rd St. in Oklahoma City. (Photo by Brent Fuchs)

This article originally appeared in the Journal Record.