Emergency Department Utilization

What is your data showing about your employees’ ER utilization?

Recent studies show that use of the Emergency Room as primary care has continued to increase over the last three decades (Ruirui Sun, Ph.D. et al). Some of these reports state that up to 71% (Beckers Hospital Review) of all Emergency Room visits could have been handled elsewhere. Employees’ lack of understanding that primary care and urgent care are a more cost-efficient way to handle non-life threatening events is one of the core problems driving this increase. Many employers, too, have a lack of understanding about appropriate site of service care. 

Many people seek the ED for non-emergency care, largely due to access barriers such as wait times for appointments and limited hours at physicians’ offices. Some of the most common complaints and diagnosis that make up avoidable ER visits include: toothache, back pain, headache, other symptoms/problems related to psychosis, alcohol abuse, dental disorders and depressive disorders (Hsia RY, Niedzwiecki M. Avoidable emergency department visits: a starting point). Many ER/ED visits are preventable, and are a result of poor health management, lack of access to care, or poor choices by the members. Charges for non-emergent conditions are significantly higher in the ED than in other settings as the ED requires the equipment to treat a wide breadth of conditions and is staffed 24/7. 

Is the Emergency Department utilization an area you can target? 

Helping members develop a game plan for care prior to needing care is imperative to driving down costs and ensuring they receive the proper care. The nature of the emergency department being a service for trauma and true emergencies lends it as one of the highest costs per claim location for service. We understand the complex nature of emergency visits vs non-urgent visits– they require the member to be aware of their options prior to when an event occurs. Member education concerning best-suited site of service, proper health management, and telemedicine empowers members to make more cost-effective decisions that are more appropriate for the care they need. By educating members you can steer them to care that is more affordable to both the member and the plan. 

Understanding your data is important in determining how your population is utilizing the Emergency Department. Here’s how you can leverage our data analytics to discover and recapture the over-utilization of the Emergency Department. 

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