The emergency room is an important staple in healthcare. However, they bring along a load of problems. How can providers, payors, and population health organizations take back control of avoidable emergency room visits?

Providers and payers do not always see everything in healthcare the same, being that they lie on two separate ends of the industry. However, they share the same desire for members to stay out of the emergency department due to overspending and overutilization which leads to unnecessary hospitalizations.

Emergency Departments are essential in the healthcare system. In 2020, there were over 131 million emergency room visits in the United States, but 55% were considered non-emergent or primary care physician (PCP) treatable. The emergency room has become a safety net for non-urgent healthcare needs or treatment of conditions that could be addressed in a primary care setting.

Identifying those patients misusing the ER is the first step in reducing avoidable ER visits and enhancing the individual care provided to each patient. For providers, payors, and population health organizations, control of avoidable ER visits and eliminating overspending begins with identification and then creating a strategy to eliminate the avoidable visits!

The Problem with Avoidable ER Visits 

Emergency department visits for non-urgent conditions strain limited healthcare resources, incur unnecessary healthcare costs, and contribute to poor care coordination. Check out the stats:

  • Most ER visits are preventable. They may indicate poor care management, inadequate access to care, or poor choices on the part of patients. (Dowd, et al., 2014).
  • ER visits for preventable or treatable conditions lower health system efficiency and raise costs. (Enard & Ganelin, 2013).
  • An estimated 13% to 27% of ER visits in the United States could be managed in physician offices, clinics, and urgent care centers, saving $4.4 billion annually. (Weinick, et al., 2010). 
  • Non-emergent ER visits lead to unnecessary hospital admissions.

The Solution to Avoidable ER Visits

At Clinigence Health, we help our clients gain control over avoidable emergency department visits with the use of the Johns Hopkins ACG system and its updated classification of emergency department visits.

Data generated by our platform produces: 

  • Increased engagement with patients
  • Reduction in gaps in care 
  • Introduces preventative care
  • Reduced need for patients to seek ER care

In today’s time, the bar for efficient patient care is set very high, partly due to the resources available to meet value-based care initiatives through technology. There is knowledge through data, and organizations must learn how to use this data for full business productivity. 

Our platform uses machine learning and advanced analytic tools that assist in the implementation of value-based contracts. The reduction in avoidable emergency department visits is one way we help reduce spending and enhance patient care.

Contact a member of our expert team today to discuss how our solution can help meet your business needs and implement proactive value-based care management!


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