Lessons from the safety net on shortening the path to high quality care
MetroHealth Care Plus Program
Transitioning from Uninsured to Medicaid coverage
Twenty-nine states, including Washington, D.C., expanded Medicaid eligibility since the Affordable Care Act opened the door to millions additional low-income Americans. Medicaid beneficiaries do much better than the uninsured on important measures of access, utilization and unmet needs, according to the Kaiser Family Foundation. How do the newly insured with chronic illness do on health care quality?

Ohio’s plans to expand Medicaid were still uncertain in 2013 when 28,945 poor, uninsured patients got health coverage in the “MetroHealth Care Plus” program. Created with a waiver from the Centers for Medicare and Medicaid Services (CMS), the program provided enrollees first-time coverage for care they received at The MetroHealth System, Neighborhood Family Practice and Care Alliance Health Center.


The cost of care for participating enrollees came in 29 percent below the CMS budget cap for the program. The quality gains were just as favorable, when 3,437 enrollees who had diabetes, high blood pressure – or both – in 2012 were compared to 1,063 similarly situated patients who remained uninsured over the same two years. Using Better Health Partnership quality performance metrics to compare the two groups over an average of nine months, enrollees’ improvements in diabetes care and outcomes were significantly better than the continuously uninsured – even though their measures of health status were worse at the start.

Lessons Learned

All three safety net systems had invested in transforming their primary care practices to optimize their use of electronic health records and create patient-centered systems of care. They also participated in public reporting and other initiatives led by Better Health Partnership.

Strong infrastructures for coordinated, patient-centered and health IT-enabled safety net organizations can deliver rapid returns on health care quality for patients with important chronic illness and limited resources.