Randall Cebul

Randall Cebul

A new study published in the July issue of Health Affairs, the preeminent journal on health care policy, found that poor, uninsured patients who enrolled in a Medicaid-like insurance plan had better care and health outcomes than those who remained uninsured. In addition, across all enrollees, total costs of care were 28.7 percent lower than the spending cap allowed by the federal government.

The study examined the impact of MetroHealth Care Plus, which extended Medicaid coverage to 28,295 Cuyahoga County residents before the expansion of Medicaid took place in Ohio. The patients enrolled in the program were previously uninsured, and were provided with primary care providers, including nurses, to help coordinate their care as needed. The program launched in February 2013, and was designed to provide the high-quality services people need to maintain their health, while also reducing health care spending. Care Plus patients formally transitioned to Medicaid when Ohio’s expansion began on Jan. 1, 2014.

“The results challenge recent reports and contribute to the ongoing debates on the value of expanding health care coverage to more poor Americans,” said Randall Cebul, president and CEO of Better Health Partnership and lead author of the study. “With well-equipped safety-net providers who came together for this program, we have seen that we can make meaningful strides in our collective quest to achieve the Triple Aim of better care, better health and lower costs.”

Cebul also is a professor in the Departments of Medicine and of Epidemiology and Biostatistics at Case Western Reserve University, as well as director of the university’s Center for Health Care Research and Policy at MetroHealth Medical Center. Four of study’s five authors are faculty members at Case Western Reserve’s School of Medicine.

“This study is yet another example of the power of data to provide important answers to key questions of care and policy,” said Pamela B. Davis, dean of the School of Medicine and senior vice president for medical affairs at the university. “I congratulate the Better Health Partnership for seizing the research opportunity that this initiative provided, as well as the institutions that participated in providing the much-needed care.”

MetroHealth Care Plus patients were cared for by three Cuyahoga County health systems that are committed to caring for everyone: The MetroHealth System, Neighborhood Family Practice and Care Alliance Health Center. All three systems are members of Better Health Partnership, a regional health improvement collaborative. The three organizations share the same electronic health record system and accepted financial risk if the total cost of care were higher than allowed by the U.S. Centers for Medicare & Medicaid Services. Instead of paying a penalty, the 28.7 percent savings by Care Plus totaled more than $41 million across the 28,295 patients.

The study used Better Health’s clinical data to look at differences in care between 2012 and 2013 among 3,437 Care Plus patients with high blood pressure or diabetes and 1,150 patients who had the same conditions but remained uninsured. Compared with continuously uninsured patients, more Care Plus patients with diabetes improved more on nationally endorsed quality of care standards, like receiving recommended eye exams on an annual basis. High blood pressure, a risk for diabetes complications, also was better controlled among Care Plus patients than those who remained uninsured in 2013. Over the study period:

  • Care Plus patients with diabetes improved 13.2 percentage points more on quality of care standards than those who remained uninsured.
  • On diabetes outcome measures, such as having blood pressure under control, Care Plus patients improved 8.2 points more than those who remained uninsured.

“MetroHealth is committed to keeping everyone in our community, including those without insurance, as healthy as they can be,” said Akram Boutros, MD, president and CEO of The MetroHealth System. “MetroHealth Care Plus proved that doing the right thing—providing insurance coverage and thoughtful, coordinated, regular care—to those who were previously uninsured not only improves their health, it reduces health care costs for all of us.”

“Care Plus was a game changer for over 2,000 uninsured patients of Neighborhood Family Practice,” said Jean Polster, CEO of Neighborhood Family Practice, with four locations in Northeast Ohio. “This early expansion of Medicaid benefited so many residents of our community, enabling them to get their medications and other needed care. Neighborhood Family Practice has seen a decrease in health disparities for our working poor families as a result of this needed coverage.”

“Through our partnership in MetroHealth Care Plus, we could offer a health insurance option to our patients, many for the first time,” said Francis Afram-Gyening, President and CEO of Care Alliance Health Center, a federally qualified health center that provides primary medical, dental and behavioral health care and supportive services to the homeless, those living in and around public housing, and the underserved. “We further increased access to essential services by removing a detrimental barrier like lack of health insurance and prepared our organization for expanded Medicaid. As a result, in 2015, 47% of Care Alliance patients are now insured, up from a 12% insured rate just a few years ago.”

MetroHealth Care Plus was also supported by:

  • Case Western Reserve University Center for Health Care Research and Policy at MetroHealth Medical Center
  • Medical Mutual of Ohio
  • Ohio Office of Health Transformation
  • Ohio Department of Medicaid