EDs could save $8.3B annually with better primary care, study finds

By | February 10, 2019

Dive Brief:

  • More effective primary care could save emergency departments an estimated $ 8.3 billion annually, according to a new Premier analysis.
  • Of 24 million visits by patients with certain chronic conditions in 2017, 4.3 million were potentially avoidable. Patients with those conditions contributed to nearly 60% of all ED visits at nearly 750 hospitals that year, Premier found.
  • Adoption of patient-focused, physician-aligned care management models could reduce the number of preventable ED visits, according to the report.

Dive Insight:

Unnecessary ED visits are a costly issue for the healthcare industry. A new study shows that coordinated delivery models and targeting at-risk populations sooner could potentially curb these costs. 

Premier analyzed nearly 24 million ED visits in 2017 of patients with at least one of six chronic conditions: asthma, chronic obstructive pulmonary disease, diabetes, heart failure, hypertension and behavioral health issues. The data showed rates of ED visits varied widely by hospital for those with chronic conditions such as behavioral health (0.8% to 64.4%), diabetes (0.1% to 22.2%) and hypertension (0.1% to 48.6%).

“It is widely known that people with chronic conditions contribute to high healthcare expenditures, making them a critical population for more strategic, preventative care,” Joe Damore, senior vice president of population heath consulting at Premier, said in a statement. “While providers face the challenge of perverse incentives that have impeded coordinated, cost-effective care delivery, Premier members are actively taking steps to overcome this fragmentation and assume responsibility for the total health of these patient populations through alternative payment models.”

These patients need more need preventative and proactive care, T. May Pini, principal of population health consulting at Premier, said in a statement. Achieving that goal requires a patient-centered care model that coordinates care across acute, ambulatory and community providers, Pini said.

The report notes that chronic disease patients visiting EDs are often uninformed about how to manage their disease and often lack access to primary care services.

To create an effective care management model, Premier outlines five steps:

  • Develop a care management vision, strategy and infrastructure that includes primary care and other providers.
  • Define, stratify and target at-risk populations.
  • Create longitudinal, individualized care plans.
  • Develop, define and articulate multidisciplinary roles and responsibilities.
  • Invest in cross-continuum technology and analytics.

As the industry strives to control costs and improve outcomes, some cities have stepped in to help rein in costs related to ED visits. In Washington, D.C., a program teams triage nurses with 911 dispatchers to divert nonemergency calls to urgent cares and outpatient clinics. The nurses also schedule primary care appointments and arrange Lyft rides for Medicare beneficiaries needing nonemergency medical assistance.

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