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;

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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