Millions of Americans visit the emergency room (ED) for non-urgent care. Those unnecessary visits cost anywhere from $4.4 billion annually according to the Agency for Healthcare Research and Quality (AHRQ), up to $32 billion a year based on a commercial study.
To keep costs down and improve care, it’s imperative that healthcare organizations find ways to reduce ED costs (also referred to as emergency department (ED) costs), no matter what type of populations they serve—from Medicaid and Medicare to commercial plan members.
When Carenet Health experts work with clients on developing ED diversion and avoidance approaches, they focus on proactive ways to influence healthcare decision-making. With a comprehensive strategy, organizations can not only empower consumers to make more informed ED visit decisions, but also improve their utilization of alternative healthcare benefits and resources and increase their safety and satisfaction. And all of that can help lower costs for patients, payers and providers.
Three ED diversion best practices to consider for your strategy
1. Proactive ED education and outreach
Consider reaching out to targeted members of your population based on claims, demographic and other data—focusing first on those with high costs and high needs, and those who are ED super users. Contact them with highly personalized data via a variety of channels. Use the interactions to educate on appropriate care settings and resources available to them. You may want to emphasize the role of less-expensive settings and services, including urgent care centers, walk-in clinics, physician’s offices and telehealth options.
2. Post-ER follow-up
Another critical tactic for reducing avoidable ED visits is contacting patients after their non-urgent ED visit—within 72 hours or less. You’ll want to talk about their need for care at the time of the trip to the emergency department and discuss how they’re feeling during the contact, too. You may want to target your list to those who were experiencing clinical conditions easily handled via telehealth and other care settings, such as sinusitis, common cold, ear infection, sprained ankle or minor cuts. These post-ED points of contact can be a great time to bring up primary care physician selection, in-network care settings and nearby urgent care locations, too.
3. Automated engagement
Another tactic we recommend is to leverage automatic health notifications. These can be sent cost-effectively to all members or a targeted audience. They are especially useful during health plan onboarding or when deployed for seasonal concerns, such as flu arrival or back-to-school season. To accomplish this, many of our clients use an interactive voice response (IVR) system, text/mobile messaging and/or email. Notifications should always promote nurse advice lines, Virtual Clinics and key virtual/telemedicine behavioral health access points to boost utilization.