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Managed care use management programs directed at reducing unnecessasry emergency department (ED) visits can be effective without the use of strict gatekeeping requirements and provider captitation agreements: that’s the take-home message of a study of 1.2 million beneficiaries of the Civilian Health and Medical Program of Uniformed Services (CHAMPUS) published in June in the Annals of Emergency Medicine.1
The study was performed to evaluate the ability of the CHAMPUS Reform Initiative (CRI) to lower the cost of ED utilization by redirecting patients to the appropriate level of care. The initiative consisted of two demonstration groups that were offered a larger selection of benefit packages, while, at the same time, introducing risk-sharing between the Department of Defense and a private contractor.
Kravitz and colleagues compared ED utilization by beneficiaries in the two CRI "demonstration areas" in California and Hawaii with that of beneficiaries in matched control areas throughout the rest of the United States over two 12-month periods.
In the CRI group, the number of CHAMPUS ED visits decreased by 40% relative to the control, and allowed charges fell by 50%.
Researchers noted that the reductions were concentrated primarily among repeat users of the ED and in patients who had less severe illnesses. In addition, the reductions were attributable to improved outpatient access to care and a "nonintrusive" use management program, the study’s conclusion states.
1. Kravitz RL, et al. Effect of a large managed care program on emergency department use: Results from the CHAMPUS Reform Initiative Evaluation. Ann Emerg Med 1998;31: 741-748.