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Blog & News

Ongoing Education on Alternate Sites of Care Can Reduce Inappropriate ER Utilization

Morgan’s persistent ear pain wasn’t overly severe, but she was concerned that it wouldn’t go away. She finally reached wit’s end late one Thursday evening and decided to head to the Emergency Room. Even though she faced an hour wait when she arrived there, she felt this was the only place she could get the help she needed so late in the evening. Her decision to head to the ER resulted in inconvenience for her and substantially higher costs across to her and to her employer.

Lack of understanding about alternative treatment locations led to unnecessary additional frustration and the highest cost treatment path.

It’s no wonder that reducing inappropriate emergency department utilization is a top goal for both population health management and value-based care programs.

Continued Prevalence of Non-Emergent ER Utilization

While it’s harder to find recent research and studies on the rates of non-emergent ER utilization, we are still seeing the prevalence of it in the APH Poindexter database of nearly 3 million lives.

According to an April 2018 article, the Healthcare Financial Management Association (HFMA) states that Emergency Department visits are dropping but nonurgent use is rising.

Ongoing, Multi-Channel Education is Key

Since so many people still think of going to the ER as their first option, many of our employer clients are finding that they are the ones who need to provide ongoing and multi-channel education to their employees about better site of care options for non-emergent conditions. They can no longer rely on what’s inserted into benefits packages at the beginning of a new plan year to provide the information that’s needed by their employees and members.

With higher and higher ER bills coming in to the plan and members, employers are learning that it’s more important than ever for them to make sure that continual reminders are sent to their employees and members about which conditions can be handled by more convenient and lower cost sites of care such as a nurse advice line, telehealth (which often also covers behavioral health), on-site or retail clinic or urgent care. They’re also sharing details on how to reach these resources, and how much lower out-of-pocket costs will be to members who utilize them versus the ER.

Keeping this information top of mind when it’s needed is the key to effective communications in this area.

Examples of good times of year to communicate site of care options are:

  • A couple of months after a new plan year begins
  • At the beginning of allergy season
  • Before the beginning of the flu season
  • Before busy holiday times such as Thanksgiving, Christmas and New Year’s (when primary care doctors and pediatricians can be harder than usual to reach)
  • During times when seasonal depression is looming

Some ways to get the message out are:

  • Social media posts on company social media pages such as Facebook and Instagram
  • Benefit portals
  • Newsletters, e-newsletters and company magazines
  • Email updates from Human Resources
  • Company wellness apps
  • Stuffers in mailers sent home
  • Hand-outs at health and wellness fairs
  • Printed materials hung on break room walls
  • Printed materials / brochures available in HR and other common areas such as break rooms
  • On annual calendars published by the company – electronic and print (some companies find attaching a refrigerator magnet with names and ways to reach alternative sites of care to be effective)

Common Misconceptions Can Inform Communications

The reasons people head to the ER for non-urgent conditions are many. Knowing the reasons your population heads there is critical in order to help you to educate them on better alternatives. Here are some common reasons:

  • My primary care doctor / pediatrician’s office wasn’t open. Heading to the ER is what comes to mine first for many people when their doctor’s office is closed. It’s important that they know about the alternatives available via your health plan – nurse advice line, telehealth, retail or on-site clinic, urgent care and more.
  • I don’t have a doctor I see regularly. Many people – especially those in younger generations also don’t value the individual provider relationship as much as they value convenient access to care at the time they feel they need it most. They are primed for just-in-time information about the site of care options you provide for their convenience.
  • I couldn’t get an appointment quickly enough at my doctor. Capacity constraints, driven by an increasing shortage of primary care doctors, makes it tough for people to obtain an appointment, especially a last-minute one. Make sure you share with them the sites of care their health plan covers – before they have trouble getting into their main doctor and head right to the ER.
  • I didn’t think my insurance plan covered telehealth / retail clinics, etc. Many consumers have heard about and seen telehealth and retail clinic options, but they don’t realize their insurance plan covers them, or how low their out of pocket costs can be through those sites of care. It’s important to be sure they know what’s covered, and co-payment details.
  • I didn’t know I could get help from a nurse or doctor after normal business hours unless I went to the ER. Many people don’t realize that there are nurses and doctors available to diagnose and treat them 24 hours a day, 7 days a week. Sharing information on how to reach these resources – affordably – will help bridge this knowledge gap.

Without knowledge of site-of-care options, it makes sense that so many people with non-critical conditions land in the emergency room, especially when they know the ER can’t turn them away.

The Advanced Plan for Health team works with our clients to identify trends in non-emergent ER use and many other high cost, high risk areas. Please contact us to learn more about the insights we can provide and action steps we can recommend to help you keep your population health costs in check.


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