Effect of a Large Managed Care Program on Emergency Department Use: Results From the CHAMPUS Reform Initiative Evaluation

摘要: Abstract Study Objective: To determine the effect of CHAMPUS Reform Initiative (CRI) on emergency department use and charges, to ascertain whether any reductions were concentrated among repeat users ED, those with less serious ED diagnoses, or selected chronic medical conditions. Methods: Participants approximately 1.2 million beneficiaries Civilian Health Medical Program Uniformed Services (CHAMPUS) residing within either 11 military hospital catchment areas in California Hawaii ("demonstration areas") matched control other parts United States. Under CRI, participants offered a choice standard indemnity plan, Preferred Provider Organization– type network-model Maintenance Organization plan. Beneficiaries encouraged alternatives for nonemergency Visits civilian EDs during two 12-month periods, before after institution compared. Results: number visits decreased by 40% relative control, allowed charges fell almost 50%. Relative under CRI seen both frequent infrequent ED. case-mix severity increased modestly (+3.5% versus +.9%). patients diabetes, hypertension, asthma sharply demonstration (by 14% 41%) but rose 4% 9%). Conclusion: In one largest managed care demonstrations ever conducted, nonintrusive management program improved access outpatient appeared reduce use, costs government. Reductions some extent severe illnesses effected without capitation provider groups strict gatekeeping requirements. [Kravitz RL, Zwanziger J, Hosek S, Polich Sloss E, McCaffrey D: Effect large use: Results from reform initiative evaluation. Ann Emerg Med June 1998;31:741-748.]