Emergency department misuse: treating the underlying causes


Wednesday, October 9, 2019 | By Amy Salls, Sr. Director, Revenue and Quality Analytics

Emergency department misuse: treating the underlying causes

Americans are making 14.1 million visits to emergency departments (ED) every year, but as it turns out, 55% of these visits turn out to be non-emergent.1  

EDs are an undeniably important feature within our healthcare delivery system, available throughout the US 24/7 to treat true emergencies. But, when people rely on the ED for care that could be managed in a non-emergent setting, it comes at a high price:  ED visits can cost thousands, and misuse/overuse can contribute to higher insurance premiums for health plan members, and can ultimately impact access to care for everyone.

Any risk bearing healthcare organization is vulnerable to the impact of ED misuse.  But there is good news: organizations can realize significant savings and improved clinical outcomes by tackling ED misuse strategically to reduce the number of unnecessary ED visits while maintaining—even improving—member access to appropriate care. 

Population Health Tools Help Curb Unnecessary ED Use

This is a highly achievable goal using population health management tools such as the ED classification algorithm in the Johns Hopkins ACG® System. The ACG® System has added an ED classification algorithm that allows you to assess your population and identify patterns of emergent and non-emergent ED use. Equipped with this knowledge, you can determine intervention strategies to meet individual member needs, resolve access-to-care issues, and improve clinical results, all to reduce your total cost of care.

Take this example: using the ED classification algorithm, you identify a member, Bill. Bill recently visited an ED to get relief from an uncomfortable skin rash that appeared after his primary care physician’s (PCP) office had closed for the day. Bill has suffered two similar episodes in the past year, and he went to the ED for treatment both times. Now that you have spotted the pattern, you intervene to provide Bill with clinical support and to reduce costs.  Your strategy could include educating Bill about nearby in-network urgent care facilities that keep extended hours, treat many common ailments and cost less than emergency departments. It can also include alerting Bill’s PCP about the emerging pattern so that she can reach out to Bill and evaluate for an underlying condition that might be causing frequent skin rashes, which is what Bill really needs.  

With Johns Hopkins ACG System’s emergency department classification you open up new possibilities to treat the underlying causes of ED misuse, create better outcomes for members, and increased savings for everyone.  Learn more about the potential cost savings associated with ED misuse reduction in our infographic, or contact us.

 

  1. Using the Johns Hopkins ACG® System, SS&C Health analyzed millions of records representative of the US population: IQVIA, formerly Quintiles/IMS, One IMS Drive, Plymouth Meeting, PA 19462;Subset of the Legacy PharMetrics Adjudicated Claims Database containing national cross-section of managed care plans, 4,064,933 Commercial, Medicaid and Medicare beneficiaries, 2015.


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