![]() Nurses and other staff can also reach out to members, providing program referrals and patient education services to targeted subsets of a population. These services are not limited to triaging incoming questions and concerns from patients dealing with acute medical decisions, such as whether to go to the ED. By helping members identify the most appropriate care setting, telephonic nurses can keep the great majority from going to the ED for non-emergencies, resulting in ROIs of 2:1 or higher. The best of these programs have ED redirection rates of 82 percent. Well-designed modern programs, which take advantage of sophisticated algorithms, data analytics, and numerous communication technologies, can be critical tools in a health plan’s value-based population health toolkit. However, telephonic nurse advice is not only a member satisfier. Members are given a phone number that they can call 24/7/365 to consult with a nurse about troubling symptoms or other health issues. Health plans have been successfully using these services for decades as a member satisfaction strategy. One tried-and-proven solution for engaging and educating members about these issues is telephonic nurse triage. Providing care in the right setting at the right time requires members to know what settings to access when. Another key participant is the patient or member. 3Ĭlearly, the issue of avoidable ED use is multi-dimensional and involves various stakeholders, including government, community agencies, healthcare providers, and health plans. A compounding problem is that a large number of patients go to the ED for behavioral health issues because there are not enough community resources for these people. As a result, Medi-Cal patients are turning to EDs. The president and CEO of Scripps Health pointed to a number of reasons for this dramatic spike.įor one, California saw a large infusion of newly insured patients after the expansion of Medi-Cal (California Medicaid), but many physicians do not accept Medi-Cal, leaving the practices that take this insurance over-crowded with long wait times. For instance, in the San Diego area, Scripps Health recorded a 160 percent increase in ED visits for non-emergencies between 20. Inappropriate ED use also varies by region. ![]() But rates are lower when only non-urgent ED visits are counted, such as visits for medical issues that could be treated the next day at a doctor’s office. The exact number of avoidable ED visits varies, from 5 percent to 90 percent, depending on what presenting health issues are considered “avoidable.” 2įor instance, should an ED visit be counted as avoidable if a patient’s severe asthma attack could have been prevented with regular primary care and follow-up? When those patients are included, ED avoidable rates are much higher. Too many ED visits are for health issues that would have been best treated in more appropriate lower-cost settings, including primary care, urgent care and at home using telehealth technologies. In general, treatment provided during an ED visit is estimated to cost about 10 times as much as similar care provided on an outpatient basis. While EDs are vitally needed facilities that save countless lives, the experience can be stressful for patients given that ED staff are often rushing to care for extremely ill or injured people. Take, for instance, the emergency department (ED). ![]()
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