Teaching timely access to outpatient care is just one tactic covered in this special report, which is based on an October 2006 audio conference sponsored by the Healthcare Intelligence Network (HIN). For Emergency Use Only: Curbing Unnecessary Emergency Room Use Through Education, Accountability and Physician Engagement provides a blueprint for health plans, hospitals and providers desiring to address and reduce unnecessary ED utilization in their populations.

In this 35-page special report, Roberta Burgess, clinical case manager, Community Care Plan of Eastern Carolina, and Gerald Kiplinger, vice president and executive director of the Georgia Enhanced Care program for APS Healthcare, detail how to target and reduce unnecessary and inappropriate ED use.

In this special report, you'll get details on initiatives and interventions for decreasing non-urgent ED use, mining data to target high-utilization, high-cost individuals, implementing an ED case management program, communicating proper ED use to targeted populations and enlisting physicians' support in care redirection and appropriate ED use.

Table of Contents

• Redirecting Care to Appropriate Settings
  • Types of Care and the Costs of Chronic Illness
  • Opportunities to Redirect Care to Appropriate Settings
  • The Role of Referral Agencies and Support Services
  • Increasing PCP Access To Reduce Emergency Care Visits
  • Call Centers Serve Multiple Purposes
  • ED Reductions a Side Effect of Healthy Together! DM Program
• Goodbye Emergency Room, Hello Primary Medical Care
  • Defining an Emergency
  • Profiles of Serial Users and Frequent Fliers
  • Benefits of Partnerships with Community Organizations, Providers
  • Communication Via Toolkits, Outreach and Self-Management
  • Mining Reports to Target High-Utilization, High-Cost Individuals
  • Case Management That Meets the Client in Their Environment
  • Motivating Physicians to Help
  • Removing the Stigma of Case Management
  • Making All Players Accountable
• Q&A: Ask the Experts
  • Determining When Screenings are Billable
  • ED vs. Urgent Care Facilities
  • The Advent of “Minute Clinics” in Retail Space
  • Case Manager Work Schedules and Case Loads
  • Models for ED “At-the-Door” Screening
  • Making the Case for Urgent Care Centers
  • Redirecting Patients to Lower Levels of Care
  • Costs for Running the “Healthy Together” Program
  • Dissecting Diabetes Results in “Healthy Together” Effort
  • Enlisting Providers’ Support for ED Redirection Efforts
  • Referral Turnaround Times
  • Responsibilities of the ED Case Manager
  • Monitoring ED Visits Related to Drug Interactions
  • Statewide DM and CM Efforts
  • Future ED Redirection Initiatives
  • Benchmarks for ED Utilization by Population
  • Analyzing ED Visits by Type of Coverage
  • Investigating FQHC-Hospital ED Partnerships
• Glossary
• For More Information
• About the Author

Emergency Exits: Reducing Emergency Room Utilization by Retooling Care-Seeking and Care Access Options

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;