Around the country, payers are developing or refining programs to reduce unnecessary emergency department utilization, redirecting so-called “frequent fliers” to primary and urgent care clinics. But a recent study finds that less than 10% of emergency department visits actually are inappropriate.
Blue Cross and Blue Shield of North Carolina last week said it’s investing in FastMed Urgent Care to help it expand the network of physician-owned urgent care clinics across the state. The insurer said thousands of its enrollees are seeking care that could be provided at an urgent care center and asserted that the partnership “increases access to convenient, high quality urgent care while reining in medical costs.” The North Carolina Blues plan’s data show that more than 20% of ER visits are for nonemergencies, the insurer said.
Meanwhile, the Blue Cross Blue Shield of Massachusetts Foundation is helping to fund the MyLink program, through which case managers approach certain patients in emergency rooms to assist them with navigating the health care system. The voluntary program is intended to connect patients to social and medical services outside emergency departments, according to the Worcester Telegram & Gazette.
And both employers and insurers are increasing cost-sharing for emergency room visits. The Employer Health Benefits 2012 Annual Survey from the Kaiser Family Foundation and the Health Research & Educational Trust found that 91% of covered workers have cost-sharing for emergency department visits. Cost sharing averages a $118 copayment or 18% coinsurance, the report found.
But a recent analysis from the Center for Studying Health System Change found that among nonelderly Medicaid enrollees, only 10% of emergency department visits were for nonurgent symptoms, compared with 7% for privately insured nonelderly patients in 2008. The report questions the conventional wisdom that benefit design and care coordination programs can eliminate widespread waste from inappropriate usage of emergency departments.
What do you think — should emergency department overutilization be a major focus for insurers and employers?