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National emergency room (ER) utilization data
tell us what hospitals and health plans see daily: that ER visits
continue to rise and show few signs of slowing. According to the
National Hospital Ambulatory Medical Care Survey (NHAMCS), there were
110.2 million ER visits in 2004, and more than 25 percent were for
non-urgent or unknown causes.
Frequent ER visitors — also referred
to as “frequent flyers” — are often
targets of ER redirection efforts. In reality, frequent flyers comprise
a very small percentage of ER visitors. Two health plans have
discovered that by analyzing patient care-seeking behaviors and
reducing barriers to primary care access, they can successfully divert
a measurable number of potential ER visitors to more appropriate care
venues.
In this 35-page special report, three
physicians share the specifics of their health plans' ER diversion
initiatives that have roots in patient self-care education, physician
office adaptability and hospital-health plan partnerships. Their
reframed approaches to emergency room utilization and primary care have
netted them significant reductions in both ER visits and hospital
admissions.
After analyzing internal and NHAMCS data,
WellPoint and Neighborhood Health Plan employed low touch, broad-based
strategies built around patient education rather than expending energy
on low numbers of frequent flyers whose behaviors are unlikely to
change, or significantly affect an organization's financial health.
This special report provides a blueprint for
health plans, hospitals and providers desiring to address and reduce
unnecessary ER utilization in their populations. It also contains a
wealth of tactics from the more than 220 healthcare organizations that
responded to HIN's e-survey on dealing with unnecessary ER visitors.
You'll hear from Karen Amstutz, M.D.,
regional vice president and medical director at WellPoint State
Sponsored Business, Lakshmi Dhanvanthari, M.D.,
staff vice president and medical director at WellPoint State Sponsored
Business, and Jim Glauber, M.D., medical director
for Neighborhood Health Plan of Massachusetts, who provide details on:
- Reducing unnecessary ER use via medical home
promotion and assignment;
- Empowering members and occasional ER users with
self-care knowledge;
- Recognizing and reporting potential
drug-seeking behaviors among frequent flyers;
- Beginning immediate outreach to ER users via
real-time health plan-hospital data exchange;
- Evaluating the effectiveness of a nurse triage
line in diverting unnecessary ER visits;
- Employing nine tactics to engage network
hospitals and providers in ER diversion initiatives;
and much more.
Table of Contents
- Neighborhood Health Plan Focuses on Patient
Care-Seeking Behavior, Primary Care Access
- Defining Non-emergent ER Use
- Drivers of Non-emergent ER Use
- Developing Strategies to Reduce ER Use
- Efforts Directed to Occasional ER Users Most
Effective
- Fostering Self-Care through Education
- Increasing Primary Care Accessibility for
Urgent Care
- Potential Impact of Retail-based Clinics on ER
Use
- WellPoint's Approach: Out of the ER and Toward
Primary Care
- “Secret Shoppers” Rate
Primary Care Experience
- Pilot Success Extends ER Initiatives Plan-Wide
- Engaging Physicians in the ER Initiative
- Hospital-Health Plan Collaboration Yields
Results
- HIN e-Survey: How 200 Healthcare Organizations
Deal with Unnecessary ER Visits
- Curbing ER Enthusiasm
- Overcoming Hurdles to Reduce ER Use
- Q&A: Ask the Experts
- Quality of the Primary Care and ER Experiences
- Funding Physicians for Home Visits
- Best Practices in Reducing Non-emergent
Utilization
- Secret Shopper Program Details
- Targeting High ER Users
- Costs and Results of ER Utilization Efforts
- Population-specific ER Interventions
- Getting Practices on Board with After-hours
Care
- Effectiveness of Self-Care Guides
- Effectiveness of Nurse Triage Lines
- Population Identification Strategies
- Glossary
- For More Information
- About the Authors
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