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California Medicaid Case Study

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California Medicaid program, also known as Medi-Cal is the largest Medicaid program in the nation. With the rollout of Medicaid expansion in 2014, the Medi-Cal is suffering an unsustainable high ED use rate. The identification of a model of care to direct patients to the appropriate setting for care has emerged as a top priority for the state’s health policy.
Safety-net clinics play a pivotal role in delivering both primary and specialty care to millions of low-income people, and yet we know little about their performance under different health care delivery models. With the implementation of Patient-Centered Medical Home (PCMH) in early 2012, where the clinics integrated patient engagement, health information technology, coordination of care, quality of care and access to care to their daily practice, it would be interesting to find out the impact of this model on the healthcare utilization of Medi-Cal beneficiaries.
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The first objective evaluated the impact of PCMH on non-disabled Medi-Cal beneficiaries. The analysis shows that among clinics with less than 10% SPD membership, transformation to PCMH was associated with increased utilization of office visits and reduced use of emergency departments (ED). In particular, PCMH clinics (relative to non-PCMH clinics) reduced ED visits by an average 70 visits per thousand members per year (PTMPY) and avoidable ED visits by 20 visits PTMPY. No significant change in office visits or reduction in ER were found in clinics with SPD membership greater than 10% suggesting that the beneficial effects of PCMH model in safety net clinics can be muted by a sudden influx of heavy
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