Emergency Room Diversion Strategy
The Challenge
The organization was seeing an alarming number of emergency room visits for non-emergent issues like ear infections and minor rashes. This was happening because employees lacked an understanding of the available alternatives and the cost implications of ER care.
The IMPACT
Excessive ER utilization was driving up the plan’s medical spend and creating an unnecessary financial burden on the employees through high copays. Leadership felt that their current benefits education was failing to influence member behavior in a meaningful way.
The Strategy
JA implemented a tiered education program and a no-cost telemedicine option to provide employees with an immediate, high-value alternative to the ER. We also provided member navigators to help employees choose the most appropriate setting for their care.
THE OUtcome
The diversion strategy led to a measurable decrease in non-emergent ER visits and an increase in the use of telemedicine and urgent care. This change in behavior lowered costs for both the employer and the employees while improving the efficiency of the health plan.
Things Employers Should Consider
Effective utilization is built on a foundation of education and access. It is not enough to simply tell employees to avoid the ER; you must provide them with a better alternative and the knowledge to use it. Employers should focus on removing the barriers to low-cost care settings to ensure the health plan is used effectively.