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


State launches HealthFacts RI database, Rhode Island’s comprehensive all-payer
claims database

CRANSTON, R.I. (February 10, 2016) – 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

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

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

“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