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Emergency Exits: Reducing Emergency Room Utilization by Retooling Care-Seeking and Care Access Options

  • ID: 579170
  • Report
  • 35 Pages
  • Healthcare Intelligence Network
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National emergency room (ER) utilization data tell us what hospitals and health plans see daily: that ER visits continue to rise and show few signs of slowing. According to the National Hospital Ambulatory Medical Care Survey (NHAMCS), there were 110.2 million ER visits in 2004, and more than 25 percent were for non-urgent or unknown causes.

Frequent ER visitors — also referred to as “frequent flyers” — are often targets of ER redirection efforts. In reality, frequent flyers comprise a very small percentage of ER visitors. Two health plans have discovered that by analyzing patient care-seeking behaviors and reducing barriers to primary care access, they can successfully divert a measurable number of potential ER visitors to more appropriate care venues.

In this 35-page special report, three physicians share the specifics of their health plans' ER diversion initiatives that have roots in patient self-care education, physician office adaptability and hospital-health plan partnerships. Their reframed approaches to emergency room utilization and primary care have netted them significant reductions in both ER visits and hospital admissions.

After analyzing internal and NHAMCS data, WellPoint and Neighborhood Health Plan employed low touch, broad-based strategies built around patient education rather than expending energy on low numbers of frequent flyers whose behaviors are unlikely to change, or significantly affect an organization's financial health.

This special report provides a blueprint for health plans, hospitals and providers desiring to address and reduce unnecessary ER utilization in their populations. It also contains a wealth of tactics from the more than 220 healthcare organizations that responded to HIN's e-survey on dealing with unnecessary ER visitors.

You'll hear from Karen Amstutz, M.D., regional vice president and medical director at WellPoint State Sponsored Business, Lakshmi Dhanvanthari, M.D., staff vice president and medical director at WellPoint State Sponsored Business, and Jim Glauber, M.D., medical director for Neighborhood Health Plan of Massachusetts, who provide details on:

-Reducing unnecessary ER use via medical home promotion and assignment;
-Empowering members and occasional ER users with self-care knowledge;
-Recognizing and reporting potential drug-seeking behaviors among frequent flyers;
-Beginning immediate outreach to ER users via real-time health plan-hospital data exchange;
-Evaluating the effectiveness of a nurse triage line in diverting unnecessary ER visits;
-Employing nine tactics to engage network hospitals and providers in ER diversion initiatives;
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- Neighborhood Health Plan Focuses on Patient Care-Seeking Behavior, Primary Care Access

Defining Non-emergent ER Use
Drivers of Non-emergent ER Use
Developing Strategies to Reduce ER Use
Efforts Directed to Occasional ER Users Most Effective
Fostering Self-Care through Education
Increasing Primary Care Accessibility for Urgent Care
Potential Impact of Retail-based Clinics on ER Use

- WellPoint's Approach: Out of the ER and Toward Primary Care

“Secret Shoppers” Rate Primary Care Experience
Pilot Success Extends ER Initiatives Plan-Wide
Engaging Physicians in the ER Initiative
Hospital-Health Plan Collaboration Yields Results

- e-Survey: How 200 Healthcare Organizations Deal with Unnecessary ER Visits

Curbing ER Enthusiasm
Overcoming Hurdles to Reduce ER Use

-Q&A: Ask the Experts

Quality of the Primary Care and ER Experiences
Funding Physicians for Home Visits
Best Practices in Reducing Non-emergent Utilization
Secret Shopper Program Details
Targeting High ER Users
Costs and Results of ER Utilization Efforts
Population-specific ER Interventions
Getting Practices on Board with After-hours Care
Effectiveness of Self-Care Guides
Effectiveness of Nurse Triage Lines
Population Identification Strategies

- Glossary

- For More Information

- About the Authors
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