Strategies for Reducing Unnecessary ER Utilization

Thursday, August 31st, 2006
This post was written by Melanie Matthews

We all know the statistics about rising use of the emergency room (ER) for perhaps unnecessary care. And we probably can all relate a story about someone who waited too long to be seen in an ER when they did in fact need immediate attention.

As part of our industry’s quest to improve quality and reduce costs, the ER is a great place to look.

AmeriChoice, a Medicaid health plan owned by United Healthcare, is placing triage case managers in facilities where they’ve had high volume ER usage. These case managers help those members identify other ways for them to receive appropriate care, Penelope Kokkinides, national vice president of disease management with AmeriChoice, told participants in Healthcare Risk Stratification: Strategies for Identifying and Referring the Appropriate Service and Intervention, an August 16 audio conference now available on CD-ROM.

AmeriChoice is also trying to find doctors who have extended hours to see if those doctors would be willing to take members on a one-time urgent basis – even providing these doctors with some type of financial incentive to have longer office hours.

Another health plan, Keystone Mercy Health Plan, is surveying at-risk patients with frequent emergency room visits to identify the factors that led to the visit and, in turn, educate the patient about appropriate ER utilization and deliver information about primary care physician access. Reports from the survey will also help Keystone identify at-risk patients and enroll them in disease management programs that can reduce costs and improve patient health.

With these and other initiatives focused on reducing inappropriate ER usage, hopefully we will all be able to tell a story about someone who truly needed ER care and received it in a timely fashion.

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