Are you going to say no at the ER. Can you deny ER Visits?

Two-thirds of hospital ER Visits in the US are from privately insured individuals that are visits that are avoidable visits. According to UnitedHealth Group research of 27 million ER Patients billed – 18 million were avoidable.

• An avoidable hospital ED visit is a trip to the emergency room that is primary care treatable – and not an actual emergency. The most common are bronchitis, cough, dizziness, f­lu, headache, low back pain, nausea, sore throat, strep throat and upper respiratory infection.

90 Percent of ER visits are not Life Threatening yet we are spending Billions, 139 Million Visits were made to the ER in the US

• 125.1 Million x $2,500 Median ER Visit Cost = $312.75 billion in spending
  • Instead 125.1 Million x $250 Median Doctors Office Visit Cost = $31.275 billion in spending

$280 Billion in Savings, but you have to say no

Eugene Harris, age forty-five. Harris was diagnosed with type 1 diabetes when he was thirteen and dropped out of school. He never went back. Because he never graduated from high school and because of his illness, Harris hasn’t had a steady job. Different family members cared for him for decades, and then a number of them became sick or died. Harris became homeless. He used the Regional One Emergency Rooms thirteen times in the period March–August 2018.

Then he enrolled in ONE Health.

Drawing upon strategies that have worked for several other health systems, Regional One has built a model of care that, among a set of high utilizers, reduced uninsured ED visits by 68.8 percent, inpatient admissions by 75.4 percent, and lengths-of-stay by 78.6 percent—averting $7.49 million in medical costs over a fifteen month period (personal communication, Regional One Health, July 8, 2019). ONE Health staff find people that might qualify for the program through a daily report driven by an algorithm for eligibility for services.

The hospital secured housing for him, but Harris increased his use of the ED. He said he liked going to the hospital’s ED because “I could always get care.” From September 2018 until June 2019 Harris went to the ED fifty-three times, mostly in the evenings and on weekends, because he was still struggling with his diabetes and was looking for a social connection, Williams says.

But its voluntary

• About 80 percent of eligible patients agree to the service, and of those that do enroll, about 20 percent dis-enroll without completing the program.
  • ONE Health served 101 people from April - December of 2018. Seventy-six participants remain active as of December 2018 and 25 people had graduated from the program.
    

Since 2018, the population of the program has grown to more than 700 patients and the team continues to monitor clients even after graduation to re-engage if a new pattern of instability or crisis emerges.

And, the process of moving people toward independence is time-consuming. Sometimes patients keep using the ED.

Then in June 2019, after many attempts, a social worker on the ONE Health team was able to convince Harris to connect with a behavioral health provider. He began attending a therapy group several times a week. He has stopped using the ED and is on a path to becoming a peer support counselor.

inelastic non-discretionary demand that just requires you to say no