How Health Plans and Providers can reduce emergency (ER) visits

Many patients visit the Emergency department seeking non-emergency medical care because of inadequate knowledge, patient ignorance, or convenience, which results in a short supply of Primary Physicians and treatment facilities to patients in need.

Unnecessary visits incur over $4.4 bn per year
According to research from Agency for Healthcare Research and Quality (AHRQ), unnecessary visits cost anywhere from $4 bn up to $32 bn; This triggers concerns for Health Plans and Providers.

Proven tips to minimize emergency department visits causing dire challenges for providers and health plans:

Educate patients to call Doctor before reaching to ED

In general, it is assumed that patients will call the respective department or physician before heading to hospitals, while that is not the case. Nevertheless, educating members with an awareness campaign to contact their physicians first can reduce emergency visits. In the awareness campaigns, hospitals can promote virtual clinics and nurse lines to be reached at the time of medical assistance such as seasonal concerns (Flu), common cold, ear infection, etc. The campaigns can be promoted in the Emergency Departments, waiting rooms, patient portals, periodic emails etc.

Provide 24/7 medical records access to the care team

On the one hand, health care organizations are educating patients to contact through virtual clinics 24/7. Still, on the other hand, this triggers a question: does Nurses or Providers have complete access to medical records after working hours? Providing round-the-clock access of medical records to care teams, MIPS eligible clinicians and groups offer seamless patient experience on telemedicine, e-visits or phone visits.

Create e-circulars that educate & direct people to the right department for treatment

Create e-circulars that map common urgent care to respective health care departments with contact information, offering complete clarity. The table with a list of common conditions and where patients should reach for quick aid will en route patients to the appropriate department while reducing unnecessary ED utilization. In addition, these e-circulars can be included in the awareness campaigns promoting 24/7 nurse helpline, virtual clinics, so on. Doing so will retrain patients whom to contact at the time of specific conditions.

Provide care specific follow up guidelines to members or Post ER follow up guidelines

Implementation of post-ER treatment-specific follow-up guidelines is to reduce non-urgent readmission visits within 72 hours of care. Therefore, hospitals must share condition-specific instructions after ER visits, such as if the temperature of a discharged patient is up to 103 degrees, can call the Doctor or take medication. And if the temperature is 104 or above, take the patient to ER.

Leveraging Real-time data platform

Hexplora’s Claims Analytics consists of dashboards, namely PMPM Trend, PMPM Details, ER visits by Member, Admit Trend by TIN, Readmissions Trend, and Drug Utilization. The tool aims to offer deep insights into the behavior of a homogenous group of patients with similar medical conditions. As a result, health plans and providers can take a deep dive into the insights to learn patients’ readmission and ER visits patterns. As a result, providers can make proactive interventions in an effort to educate patients to contact the right department or contact via virtual clinics or 24/7 helpline.

HEXPLORA – a comprehensive Healthcare Data Warehousing and Analytics solution that includes:

  • Rich set of Utilization Metrics
  • Integrated HEDIS Quality Reporting
  • Claims Analytics (Admissions, ER visits, PMPM Trends)
  • Enrollment Analytics (Enrollment Trends, Member Months)
  • Quality Analytics including Care gaps
  • Condition-based Analytics (HCC gaps and trends)
  • HCC Risk adjustment Optimization