Volunteer State Health Plan Receives $2.4 Million Grant to Assist TennCare Members

Funding to Improve Access to Primary Care, Reduce Unnecessary ER Visits

Volunteer State Health Plan (VSHP) and Erlanger Health System were recently awarded a $2.4 million grant from the Centers for Medicare and Medicaid Services (CMS) for the creation of programs and services to help Medicaid beneficiaries get appropriate non-emergency care.

VSHP and Erlanger worked collaboratively on the grant proposal, which outlines plans for a health clinic on Erlanger’s main campus which will aid TennCare members seeking non-emergent care in Erlanger’s emergency department. Additionally, the funding will establish a program to encourage TennCare members to develop relationships with their primary care providers and learn about appropriate emergency room use.

“This funding provides a first step in what we believe will become a model for how to best educate and transition members to more accessible and convenient non-emergency care alternatives,” said Sonya Nelson, president and CEO of VSHP. “Not only will this effort help our members build relationships with their primary care physicians and keep them actively involved in their health care, but it will also alleviate overcrowding in the ER and help lessen the use of costly hospital emergency rooms for non-emergencies.”

According to the Bureau of TennCare, the average emergency department visit rate for Medicaid patients in Tennessee during 2006 was 76.6 per 100 persons. VSHP figures show the emergency room visit rate for BlueCare and TennCareSelect members was 78.5 per 100 members for the period April 2006 to March 2007. This is higher than the overall emergency department visit rate for the state of Tennessee.

This project is expected to directly impact the 34,330 VSHP members living in Hamilton County, Tenn. served by the main campus of Erlanger and its community health centers.

The grant was announced as part of a broader CMS program awarding federal funds totaling $37.5 million and reaching twenty states across the country, with an additional $12.5 million to be awarded in 2009. The grants are part of ongoing efforts to implement effective reforms to slow spending growth while maintaining access to coverage.