Expert Insight
A deeper dive
How to crunch data to manage ER utilization and contain health costs
E
mergency room overutilization is
a prevailing problem, and more
than 65 percent of ER visits are for
nonemergency reasons. These are
generally for disease and viruses or symptoms
such as headaches, gastroenteritis, sinusitis
and influenza.
“The cost of an average ER visit ranges
from $1,300 to $1,500, but the average
urgent care or client visit ranges from $120
to $500,” says Mark Haegele, regional vice
president of sales at HealthLink.
“If you move those visits from the ER
to other care settings, you’re saving roughly
$1,000 per visit. And hundreds of visits add
up to hundreds of thousands of dollars.”
Here’s how employers can turn member
information into intelligence to control
plan costs.
What’s the first step to
decreasing ER utilization?
Look at your health plan membership data
for patterns, then focus on a communication
strategy and specific messaging to change
behavior. Determine the number of visits
your group has in 12 months, comparing
that year over year. Even if there’s no increase,
there are opportunities for cost containment.
Also, see if you have a frequent flier
issue. Are people going to the ER three or
more times in a year? Determine which
days people are going. If there’s a spike on
weekends, educate members on how to
access other care settings on Saturday or
Sunday. Look at where emergency care is
taking place. Is it isolated to a particular
community, or split across a region? Finally,
break visits down by disease, virus and
symptom, versus injuries and poisonings.
Then set up metrics. If your average
number of ER visits has been consistently at
X per 1,000, eliminating 30 or 40 percent of
visits for disease, virus or symptoms is your
target for the following year.
How can employers educate
and influence health plan
members?
Develop a multifaceted communication
strategy. Create one piece of communication
that goes to all members, such as a flier on the
proper use of the ER. And reach out to certain
groups, such as frequent fliers, differently.
Use information about which hospitals
members are visiting to generate a directory
of urgent cares around the same ZIP code and
ensure that members know the number for the
health plan’s 24-hour informational nurse line.
The more you share specific costs, the
better people will respond. Include a grid that
shows the cost to the employer and member
for different care settings. Communicate
nonemergency diseases or symptoms that
create overutilization, and put it in plain
English. However, be careful. You don’t want
to tell people not to go to the ER. It’s about
awareness and education.
What about raising co-pays?
Higher co-pays get people out of the ER,
but raising the cost has become abused,
and it often gets shifted from the employer
to members. Before you start digging into
members’ pockets, give them the opportunity
to do the right thing. :
Watch HealthLink’s video, “Getting care
when you need it quickly” to see when
to use the ER, at www.healthlink.com/
ERalternatives.asp.
The Link • 7