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HealthFacts RI Report Shows Potentially Preventable Emergency Room Visits Cost Rhode Islanders $90M Each Year

Rhode Island launched today the HealthFacts RI database, a new all-payer healthcare claims database, to better understand healthcare spending, utilization and the effectiveness of healthcare policies. As part of the launch, the state's Executive Office of Health and Human Services (EOHHS) released a report from the database which highlights the need for transformation across the state's entire healthcare industry to foster healthier communities and help more Rhode Islanders avoid preventable visits to the emergency room.

The report found that nearly 60 percent of all visits to Rhode Island emergency rooms in 2014 were potentially preventable, including nearly half of the visits to the emergency room paid for by private insurance and seven out of 10 visits by patients with Medicaid or Medicare. In all, potentially preventable emergency room visits cost Rhode Islanders as much as $90 million each year, including $18 million in additional Medicaid spending, $33.1 million in Medicare and nearly $40 million in private healthcare spending.

"In order to build a sustainable, 21st century healthcare system, we need to pay for better outcomes, better quality and better coordination instead of greater volume. Preventing avoidable emergency room visits by investing in better health will save Rhode Islanders money and help more people live happier, healthier and in many cases longer lives," said Health and Human Services Secretary Elizabeth Roberts. "I believe strongly that the things that get measured are the things that get done. The HealthFacts RI database is essential to tracking the reforms we've put in place and developing new innovations to reinvent Medicaid and transform healthcare."

The top reasons for potentially preventable emergency room visits vary by payer type, according to the report. Alcohol abuse, teeth disorders and upper respiratory infections were especially prevalent among the Medicaid population. Chest pain, dizziness and urinary tract infections were particular to the Medicare population. Neck sprains, headache and chest pain were among the top reasons for privately insured patients. EOHHS will release updated data from this report every three months.

In addition, upon reviewing the state's potentially preventable emergency room visit data, Medicaid Director Anya Rader Wallack has directed the Medicaid office to regularly convene a group that includes the state's Medicaid managed care organizations to monitor trends and develop interventions to reduce preventable visits.

"We are aggressively implementing an ambitious, progressive package of Medicaid reforms that achieve tens of millions of dollars in savings without cutting eligibility or reducing benefits. To hit our savings targets, we must transform the way we deliver and pay for care and reduce potentially preventable emergency room visits," said Medicaid Director Anya Rader Wallack. "The HealthFacts RI database is a powerful tool to hold us accountable for reaching the goals we've set to improve health and lower costs."

The Reinventing Medicaid reforms passed last year achieved significant savings and laid a strong foundation to move Rhode Island's Medicaid system toward a structure that pays for better outcomes, better coordination and better quality care, instead of paying just for volume of services. Governor Gina M. Raimondo's progressive package of reforms included a number of initiatives targeted specifically to drive down the number of avoidable emergency room visits, including the creation of Medicaid accountable entities to improve care coordination and the establishment of integrated health homes for members with severe and persistent mental illness.

Through the Working Group for Healthcare Innovation, which was created to address growing healthcare costs across the entire system, the Rhode Island Department of Health has established a series of population health goals. The goals seek to remove barriers to better health, encourage preventive care and reduce potentially preventable use of healthcare services.

"The policies we develop based on data gathered through HealthFacts RI will be instrumental in our work to build healthier communities and help more people make it in Rhode Island," said Nicole Alexander-Scott, MD, MPH, Director of Health. "Eliminating barriers to healthy lifestyles and helping everyone have an equal chance at good health depend on improvements in the overall quality, cost, and efficiency of care."

The HealthFacts RI database is the most comprehensive collection of healthcare claims data that the state has ever compiled and is integral to support Raimondo's efforts to spark innovation across the state's entire healthcare system. The database includes data from nearly 825,000 Rhode Islanders with claims totaling $18 billion between 2011 and 2014. Rhode Island is one of just 18 states to launch an all-payer claims database. The state has taken extensive precautions to protect patient privacy while ensuring that the data is useful to the state's health and human service agencies, legislators, researchers and policymakers.

"The HealthFacts RI database provides the State of Rhode Island with an extremely valuable resource it has never had before. We will be able to understand where all healthcare dollars are being spent and use this information to advance our efforts to contain costs. We strive to provide consumers some relief in healthcare expenditures so they have predictable, affordable healthcare expenses," said Rhode Island Health Insurance Commissioner Kathleen C. Hittner, MD.

EOHHS and its partners will make certain datasets available for the general public on the HealthFacts RI website and will release regular reports. In addition, EOHHS will share graphs, facts and key data points on a Twitter account devoted to the HealthFacts RI database: @HealthFactsRI. In the coming weeks, additional data will be made available for researchers and other outside organizations for a fee.

The HealthFacts RI database is a partnership led by EOHHS, with support from HealthSource RI, the Office of the Health Insurance Commissioner and the Rhode Island Department of Health. It includes claims information from all major insurers in Rhode Island that cover more than 3,000 Rhode Islanders, including Medicaid and Medicare.

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