The Oklahoma Health Care Authority (OHCA) is taking aim at inappropriate use of the emergency room by Medicaid recipients in an effort to pair them with more efficient and economical health care.

The ER Utilization project, implemented in 2004, addresses factors that may play a part in the utilization of the ER. The agency has found that in FY 2005 alone, more than $35.5 million has been spent for ER services to some 189,830 recipients, about 28 percent of the total Medicaid population. Four percent of that population had six or more ER visits in one year.

In an effort to bring members' ER utilization down, the OHCA has taken a two-prong approach, targeting both recipients and provider factors that may be at play. On the provider side, the agency has been profiling ER utilization by enrollees who are assigned to individual SoonerCare providers. The ER provider profiles are mailed to providers on a bi-annual basis for a rolling 12-month period. The profiles are a tool for the OHCA to communicate with providers and should make them aware of the habits of their patients so they can work with them accordingly.

By managing these Medicaid recipients' health care needs, the agency is hoping to decrease the number of ER visits and therefore encourage more efficient use of health care dollars.

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