Wisconsin Evaluation of Emergency Department Care Coordination

Evaluation of an Intensive Care Coordination Program to Reduce Use of Hospital Emergency Department Services by Wisconsin Medicaid Members

The State of Wisconsin is now expanding its investment in care coordination models as an effort to reduce inappropriate hospital emergency department (ED) use, improve health outcomes, and reduce Medicaid expenditures. This effort begins with a pilot program to support emergency department care coordination in hospitals and health systems that apply and are selected to participate in the pilot program.

The Wisconsin Medicaid program seeks to understand whether this program achieves its intended goals and, specifically, whether the Medicaid payment for such care coordination services produces the intended program outcomes. Hospitals will select members that will receive care coordination services. In a quasi-experimental approach, the study team will compare members that do vs. do not receive the services will be used examine the effects of care coordination and referrals on total ED visits, primary-care treatable ED visits, non-emergent ED visits, and health care costs, as well as the specific effects of referring patients to providers who offer low-cost and after-hours care. To assess the importance of targeting, study team will conduct stratified analyses of vulnerable groups such as people with disabilities and individuals with specific clinical needs.

Study Overview

• Status: Completed
• Conditions: Emergency Department Visit
• Intervention / Treatment: Other: Intensive Care Coordination

• Study Type: Observational
• Enrollment (Actual): 3405

Contacts and Locations

Study Locations

• United States
  • Wisconsin
    • Appleton, Wisconsin, United States, 54911
      • ThedaCare
    • Glendale, Wisconsin, United States, 53217
      • Ascension Wisconsin
    • Milwaukee, Wisconsin, United States, 53202
      • Aurora Health Care
    • Wauwatosa, Wisconsin, United States, 53226
      • Froedtert Health , Wisconsin

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years to 64 years (Adult)
• Accepts Healthy Volunteers: Yes

• Sampling Method: Non-Probability Sample

Study Population

Inclusion Criteria:

• Adults who are Medicaid enrolled
• Have had 5+ emergency department visits in the past year

Exclusion Criteria:

• Participants who are concurrently eligible for Medicare
• Children (individuals age <18 years).

Description

Inclusion Criteria:

• Adults who are Medicaid enrolled
• Have had 5+ emergency department visits in the past year

Exclusion Criteria:

• Participants who are concurrently eligible for Medicare
• Children (individuals age <18 years).

Study Plan

How is the study designed?

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Intensive Care Coordination; Intensive Care Coordination along with Standard of Care	Other: Intensive Care Coordination; Intensive care coordination will include: Discharge instructions and contacts for following up on care and treatment; Referral information; Appointment scheduling; Medication instructions; Intensive care coordination by a social worker, case manager, nurse, or care coordinator to connect Medical Assistance (MA) recipient to a primary care provider or to a managed care organization; Information about other health and social resources, such as transportation and housing; Sharing of information (discharge instructions, medication information, and care plan information) with managed care organization in which patients are enrolled, if applicable
Control; Standard of Care alone

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Total Number of Emergency Department Visits	6 months
Total Number of Emergency Department Visits	12 months
Total Number of Emergency Department Visits	18 months
Total Number of Emergency Department Visits	24 months
Total Number of Emergency Department Visits for Primary Care Preventable and/or Non-Emergent Conditions	6 months
Total Number of Emergency Department Visits for Primary Care Preventable and/or Non-Emergent Conditions	12 months
Total Number of Emergency Department Visits for Primary Care Preventable and/or Non-Emergent Conditions	18 months
Total Number of Emergency Department Visits for Primary Care Preventable and/or Non-Emergent Conditions	24 months
Cost to Medicaid for all Emergency Department Visits	6 months
Cost to Medicaid for all Emergency Department Visits	12 months
Cost to Medicaid for all Emergency Department Visits	18 months
Cost to Medicaid for all Emergency Department Visits	24 months
Cost to Medicaid for Emergency Department Use for Primary Care Preventable and/or Non-Emergent Conditions	6 months
Cost to Medicaid for Emergency Department Use for Primary Care Preventable and/or Non-Emergent Conditions	12 months
Cost to Medicaid for Emergency Department Use for Primary Care Preventable and/or Non-Emergent Conditions	18 months
Cost to Medicaid for Emergency Department Use for Primary Care Preventable and/or Non-Emergent Conditions	24 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Total Number of Primary Care Visits		6, 12, 18, and 24 months
Number of Participants Who Used Any Primary Care Visits		6, 12, 18, and 24 months
Number of Participants Who Used Specialty Care Visits		6, 12, 18, and 24 months
Total Number of Specialty Care Visits		6, 12, 18, and 24 months
Number of Participants with Any Hospitalizations		6, 12, 18, and 24 months
Number of Hospitalization Events		6, 12, 18, and 24 months
Number of visits to use behavioral health resources, if applicable for the participant		6, 12, 18, and 24 months
Number of visits to use alcohol and other drug abuse resources if applicable for the participant		6, 12, 18, and 24 months
Total Cost Related to the Use of Behavioral Health Resources if applicable for the participant		6, 12, 18, and 24 months
Total Cost Related to Use of Alcohol and other Drug Abuse Resources if applicable for the participant		6, 12, 18, and 24 months
Total costs of care to Medicaid		6, 12, 18, and 24 months
Number of participants enrolled in Temporary Assistance for Needy Families (TANF)		6, 12, 18, and 24 months
Number of participants enrolled in FoodShare	FoodShare is a program that helps people with limited resources buy the food they need for good health.	6, 12, 18, and 24 months

Collaborators and Investigators

• Sponsor: University of Wisconsin, Madison
• Investigators: Principal Investigator: Rebecca Myerson, MPH, PhD, University of Wisconsin, Madison

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2022
• Primary Completion (Actual): December 15, 2024
• Study Completion (Actual): December 15, 2024

Study Registration Dates

• First Submitted: September 9, 2020
• First Submitted That Met QC Criteria: September 14, 2020
• First Posted (Actual): September 16, 2020

Study Record Updates

• Last Update Posted (Actual): March 25, 2025
• Last Update Submitted That Met QC Criteria: January 8, 2025
• Last Verified: January 1, 2025

More Information

Terms related to this study

• Keywords: Medicaid; CARES (Wisconsin Client Assistance for Re-Employment and Economic Support)
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: 2020-1211; A538500 (Other Identifier: UW- Madison); SMPH/POP HEALTH SCI/POP HEALTH (Other Identifier: UW Madison); MSN240705 (Other Grant/Funding Number: DHHS, CENTERS FOR MEDICARE & MEDICAID SE); Protocol Version April 2020 (Other Identifier: UW Madison)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No