The Business Case and Value of Improving Medical Home Care for Colorado Children While Reducing Emergency Department and Hospital Utilization , 2015

This report summarizes our analysis of 2014-2015 trends in Colorado emergency department (ED) and hospital utilization rates for children with public or no insurance (Public/No) as compared to children with private insurance (Private). It reaches four important conclusions:  Increasing numbers of Colorado children had public health insurance (Public) in 2015 while a remaining 51,000 still had no insurance coverage (No).  Compared to privately-insured children, more Colorado children with Public/No insurance have emergency department visits (68.3% vs. 14.2%) and hospitalizations (3.6% vs. 1.5%) with excess costs of utilization amounting to an estimated $214 million per year.  Small area differences in excess utilization rates between Colorado RCCOs as well as the actual differences between Public/No and privately-insured children suggest that “medical home” strategies could be enhanced in both private practice and FQHC settings to reduce excess ED and hospital utilization, resulting in improved care and significant cost savings.  The value (quality/cost) relationship between health care provided in medical homes vs. emergency departments should be addressed to assure the best care is provided at the lowest cost. Overview Since 2000, there has been a gradual increase in the percentage of Colorado children covered by public health insurance, compensating for a decrease in those covered by private insurance, while significantly reducing the percentage of children with no health insurance (Figure 1). This trend has continued to accelerate with the implementation of the Affordable Care Act, almost doubling the number of publiclyinsured children.