Tools address non-urgent ER use

September 1, 2010

When it comes to minor care episodes, time isn't the only thing wasted in emergency rooms. Anthem Blue Cross and Blue Shield in Virginia recently launched a program to reduce unnecessary emergency room visits.

NATIONAL REPORTS-When it comes to minor care episodes, time isn't the only thing wasted in emergency rooms. Anthem Blue Cross and Blue Shield in Virginia (BCBSVA) recently launched a program to reduce unnecessary emergency room visits and the excess spending associated with such visits.

According to the plan's research of claims data for fully insured members, more than 60% of ER visits were for non-emergency health issues that could have been treated in urgent care facilities. The average total cost per visit was $441 for emergency room services, $98 for urgent care and $52 for retail or convenient care.

"One of the goals of this initiative is to provide educational information on true emergencies and those medical conditions that can be treated in an urgent care center, a physician's office or a retail health clinic," says Jay Schukman, MD, regional vice president and medical director, BCBSVA.

"By reviewing claims data, we can identify members that visited the ER for a non-urgent issue that potentially could have been treated at an urgent care center or retail health clinic," Dr. Schukman says.

Service representatives can use interactive voice response technology to contact individual members by phone to inform them of ER alternatives. Members can also utilize online tools to choose the appropriate care facility. BCBSVA created a Google Map that charts retail clinics, urgent care facilities, and walk-in physician offices across the state, and eventually, an iPhone application with care sites will be available.

In addition, members can call the 24/7 nurse hotline for assistance in finding an appropriate nearby facility.

"We trained our nursing staff prior to implementing the program and feel confident that we will be able to handle an increase in calls that we feel this initiative will generate," says Dr. Schukman.

Programs for appropriate use of emergency services can be a balancing act because many plans are wary to discourage emergency care if it is needed. Dr. Schukman says that plans should start with an educational program defining what is considered an emergency and what can be treated elsewhere.