Innovation comes in many forms. Sometimes it's just a matter of looking at something in a different way - like moving pieces of a puzzle around the board. ideastream's Sarah Jane Tribble explains how a Cleveland hospital did just that to get a jump on Medicaid expansion.
Carmen Smith remembers the day about a year ago she gained Medicaid coverage.
"We went in July and it was like Christmas Day, it was like getting a gift from Santa Claus. People don't realize how important and how special it is to have insurance to be able to go see a doctor on a regular basis when you have an illness like mine," Smith says.
Smith is a Type 2 diabetic. Before qualifying for Medicaid coverage, Smith was what policy experts call a "frequent flier." She had used the emergency room five times in one year.
She bought insulin over the counter, guessed at her dosage and frequently got sick.
"I remember one instance when my sugars were up and I felt like I was having a heart attack. So it was like heart palpitations. And I ended up staying in the emergency room's 24-hour observation department," Carmen says.
That kind of triage care is expensive. Smith couldn't pay the bills but she made too much to qualify for Medicaid.
Cuyahoga County's safety-net hospital MetroHealth, has struggled for years to cover the costs of patients like Smith.
So long before Ohio's Gov. John Kasich pushed through statewide expansion of Medicaid, MetroHealth's government affairs leader had an idea that came out of his previous experience as a state Medicaid director.
"And when you work in state government in the Medicaid program you're always on the lookout for how can I match state dollars or local dollars to expand access to healthcare," Corlett says.
The hospital redirected more than $30 million dollars it receives from county taxpayers each year into a new pot. They used the money to create their very own Medicaid program.
"All of the clinical outcomes are really amazing," says Dr. Randy Cebul, director of Better Health Greater Cleveland as well as director of the Case Western Reserve University- MetroHealth System Center for Health Care Research and Policy and professor of Medicine, Epidemiology and Biostatistics at CWRU School of Medicine, MetroHealth campus.
"The diabetes outcomes were probably the most impressiv," Cebul says. "The sugar control, the blood pressure control, the lipid control, virtually everything was much better and dramatically so."
MetroHealth, used extensive electronic records to carefully select patients and sent them Medicaid insurance cards before they even applied. Then, they gave each patient personalized attention.
They assigned each patient a nurse. That nurse booked their appointments, called them if they missed one and checked to make sure they took their meds.
Emergency department visits dropped 60 percent. AND primary care visits went up 50 percent.
The hospital ended up spending less on the program than expected, saving an average of $150 on each patient every month.
"Better care, better outcomes, better costs," Cebul says.
Outside of Cleveland - a handful of cities and states expanded Medicaid earlier than the rest of the nation. But results haven't always been so promising.
In Oregon, for example, emergency department use went up, not down.
They ran their program differently - choosing newly eligible Medicaid patients randomly and didn't do any of patient oversight that Cleveland did.
Healthcare providers are still comparing notes to identify best practices.
Back at Carmen Smith's house on a recent Friday night, Smith isn't interested in best practices. Instead, she wants to talk about riding a bike - something she couldn't do a year ago.
"I'm really excited 'cause I'm doing a good job. I feel so good about myself. I get off my bike and I'm like out of breath. I'm not tired but I know it's high cardio," Smith says.
Smith says she can't wait to call her nurse and talk about blood sugar levels.