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The hospital emergency room is the de facto primary care provider for 28 percent of Americans seeking acute care, according to a study published in the September 2010 edition of Health Affairs.
To reduce avoidable ER visits, Kaiser Foundation Health Plan and WellPoint have implemented tactics driven by technology, patient education and community collaborations. 27 Interventions to Reduce Avoidable ER Use describes 27 separate initiatives launched by Kaiser and WellPoint around the country that are effectively reducing avoidable emergency department use and redirecting patients to more cost-effective care venues.
This 45-page resource details provider- and patient-focused interventions that target the high numbers of avoidable visits, high and ultra-high utilizers and the sub-populations noted for frequent ER use. Five interventions target these sub-populations: asthma patients, those recently discharged from the hospital, non-network patients, nursing home and assisted living residents and dual-eligibles (Medicare and Medicaid).
Reporting on their organizations' initiatives to curtail wasteful healthcare utilization in the ER are Sara A. Tracy, senior manager of emergency services at Kaiser Foundation Health Plan of Colorado, Dr. Karen Amstutz, vice president and medical director of Medicaid and Senior Markets, WellPoint, and Dr. Barsam Kasravi, managing medical director for state-sponsored programs, WellPoint. Drs. Amstutz and Kasravi also share trends in ER use by Medicaid beneficiaries.
In presenting the 27 specific interventions, this report provides details on:
and much, much more.
- Three reasons why 36 percent of ER visits are for conditions that could be seen by a primary care provider or in an urgent care setting;
- The 15 diagnoses associated with avoidable visits conditions that may be better handled in a primary care setting;
- Use of standardized scripts by medical offices as part of an overall patient education effort;
- Sample questions for patient and health plan member surveys to gauge satisfaction and access;
- Upstream interventions and 'pre-patriation' processes designed to reach potential high utilizers before they arrive in the ER;
- Data on savings associated with specific interventions;
- Seven tactics to identify and manage members who have a known chemical dependency;
- Aggressive case management tactics for high ER users (more than 10 visits a year or $15,000 spent in the ED) and ultra-high ER users (more than 15 visits a year);
- Recommendations on use of narcotic contracts to curtail visits by chemical dependency members;
- How WellPoint and Kaiser use real- and near real-time ED data to create ED census and registries that drive program improvements;
- Plans for future expansion;
- Responses to more than 40 questions related to reducing avoidable ER use;