Reducing Avoidable Medicaid ER Visits With a Community Partnership Approach

Anxiety caused by the wait for a non-urgent appointment or lack of awareness that they are assigned a primary care physician are just two barriers to appropriate ER utilization by a diverse Medicaid population, explains Laura Linebach, director of quality improvement at L.A. Care Health Plan. As part of a health plan-hospital collaboration with a goal of reducing non-acute ER use by children ages 1 to 19, L.A. Care Health Plan has launched a Nurse Advice Line and developed a range of materials to educate parents about appropriate use of the ER. Ms. Linebach describes these tools as well as a metric in L.A. Care Health Plan’s pay for performance program that measures group providers’ appropriate resource use.

Laura Linebach presented during Reducing Avoidable Medicaid ER Visits With a Community Partnership Approach, a 45-minute webinar on May 9, 2012, during which she will share the inside details on how the health plan worked with the hospital to target avoidable ER use and results from the initiative.


Length: 5:51 minutes

Second Annual Benchmarks in Reducing Avoidable ER Use: Pain Management Driving ‘Ultra Utilizers’

The use of nurse-only health advice lines to reduce avoidable ER visits is up 10 percent over 2010 levels, according to HIN’s second annual survey on reducing avoidable emergency room use. In this podcast, Melanie Matthews shares key metrics from the 2011 survey, including program availability, health advice line use, new benchmarks on contributions from health coaches and health educators in this area and the biggest barrier to program launch.

Also, Dr. Mina Chang describes the methodology behind Ohio Medicaid’s interventions to encourage appropriate ED utilization by this population.

Need more information on this topic? Download an executive summary of the survey results.


Length: 3:00 minutes

Reducing Avoidable ER Visits by Medicaid Patients Through Quality-Based Interventions

An Ohio collaborative of Medicaid plans is using a rapid cycle quality improvement approach to reduce avoidable ER visits by its Medicaid beneficiaries. One of the five regions targeted by the collaborative is Toledo, Ohio — known for having the highest emergency department utilization in the nation. Mina Chang, Ph.D., of the Bureau of Health Services Research for the Ohio Department of Job & Family Services, outlines the framework of the collaborative. She explains its population-based and patient-centered approach and describes some of the priority populations targeted by the collaborative’s interventions.

Dr. Chang will describe how the collaborative is developing actionable interventions to address the patient streams most likely to use the ED inappropriately during a June 23, 2011 webinar, Reducing Avoidable ER Visits by Medicaid Patients Through Quality-Based Interventions, sponsored by The Healthcare Intelligence Network.




Length: 4:27 minutes

Avoidable ER Visits: Reduction and Prevention Benchmarks


How are healthcare organizations encouraging appropriate use of the emergency room in their populations?

In this month’s healthcare benchmarks podcast, Healthcare Intelligence Network executive VP and COO Melanie Matthews shares metrics from HIN’s July 2010 survey on reducing avoidable ER visits, with relevant commentary from Dr. Barsam Kasravi, managing medical director for state-sponsored programs at WellPoint; and Sara Tracy, senior manager of emergency services at Kaiser Foundation Health Plan of Colorado.

More actionable data on reducing avoidable ER use is contained in 2010 Performance Benchmarks in Reducing Avoidable ER Visits, a 50-page report derived from responses from 90 healthcare organizations. Presenting this data in more than 30 easy-to-follow graphs and tables, this resource documents trends and metrics from emergency departments across the country that are successfully managing ER utilization.




Length: 4:22 minutes

Embedded Case Managers in the Emergency Department

Organizations should advocate for a case manager in the emergency room, says Toni Cesta, senior vice president of operational efficiency and capacity management at Lutheran Medical Center. Making the business case for an ED-embedded case manager, Cesta shares key targets for case management intervention in the ED and describes how the ER case manager is positioned to improve patients’ transitions in care.

Cesta explored how to effectively structure an ED-based case management program and the potential impacts of an embedded case manager in the ED during Embedded Case Managers in the Emergency Department, a 60-minute webinar on November 3, 2010.




Length: 4:23 minutes

Healthcare Performance Metrics: How to Reduce Avoidable ER Visits

In a new monthly podcast, Healthcare Intelligence Network executive VP and COO Melanie Matthews shares the latest market research on key healthcare topics. This month’s metrics are derived from HIN’s July 2010 survey on Reducing Avoidable ER Visits, with commentary from Dr. Barsam Kasravi, managing medical director for state-sponsored programs for WellPoint and Sara Tracy, senior manager of emergency services at Kaiser Foundation Health Plan of Colorado.

More actionable data from 90 healthcare organizations on their efforts to reduce inappropriate use of the ED is contained in 2010 Performance Benchmarks in Reducing Avoidable ER Visits, a 50-page resource documenting trends and metrics from EDs across the country that are successfully managing ER utilization.




Length: 4:23 minutes

Reducing Avoidable Emergency Room Visits: Approaches to Redirect Patients to Cost-Effective Care Settings

Three key factors influence consumers’ use of the hospital emergency room today, according to Dr. Barsam Kasravi, managing medical director for state-sponsored programs for WellPoint. In this podcast, Dr. Kasravi discusses how WellPoint is trying to close critical care gaps and encourage its members to utilize healthcare services more effectively.

Dr. Kasravi and Dr. Karen Amstutz, vice president and medical director of Medicaid and senior markets, described WellPoint’s efforts to reduce avoidable emergency room visits during Reducing Avoidable Emergency Room Visits: Approaches to Redirect Patients to Cost-Effective Care Settings, a 45-minute webinar on September 1, 2010.




Length: 3:44 minutes

Reducing Unnecessary Emergency Room Visits: Strategies To Discourage Inappropriate Use and Reduce Preventable Visits

When primary care isn’t available, several proxy healthcare services can sometimes fill the bill for certain conditions, helping to reduce the number of avoidable emergency room visits, explains Sara Gray, senior manager of emergency services at Kaiser Foundation Health Plan of Colorado. Ms. Gray describes two important steps hospitals can take when discharging patients to keep those patients from seeking post-discharge care in the ER, and suggests a hospital-SNF partnership to reduce preventable ER visits by SNF patients.

Ms. Gray shared Kaiser’s three-pronged approach to reducing inappropriate and avoidable ED use during Reducing Unnecessary Emergency Room Visits: Strategies To Discourage Inappropriate Use and Reduce Preventable Visits, a 45-minute webinar on June 9, 2010.


Length: 3:40 minutes

Reducing Avoidable Hospital Readmissions: A Case Study from Priority Health

Priority Health members play an active role in keeping themselves out of the hospital, explains Mary Cooley, manager of case and disease management at Priority Health. She describes the four-point strategy that is reducing readmissions at Priority Health, the challenges that still exist and the essential tool that Priority supplies to help providers identify and close care gaps.

Cooley provided more details on the strategies that Priority Health is using to reduce avoidable hospital readmissions during Reducing Avoidable Hospital Readmissions: A Case Study from Priority Health, a 45-minute webinar on November 18, 2009.




Length: 7:23 minutes