Predicting ER visits to help reduce waste and the cost of care through
30-day ER, high-utilizer/"frequent flier" and inpatient predictions
Three-quarters of Emergency Department (ER) visits do not require immediate attention or are preventable through outpatient care. Of these visits, 21-28% are made by what many in the industry call "frequent fliers:" those patients with manageable chronic conditions who regularly visit the ER. These individuals may visit the hospital 10 times a year and help explain why 80% of all healthcare costs are spent on just 20% of the population.
While inappropriate use of the ER is a major source of waste within the healthcare system, the causes driving these visits aren’t necessarily the fault of the individual patients. Studies suggest that early intervention, coordinated care, and targeted treatments effectively divert patients from the ER, help to manage the chronic conditions that contribute to ER visits, and improve quality of life.
But ER visits and "frequent fliers" have been historically difficult to predict. And hospitals have struggled to forecast unreimbursed episodes of ER care to more effectively budget and manage expenses.
Using Jvion's Cognitive Clinical Success Machine, we help hospitals target avoidable ER visits and better manage costs by providing a high-definition view into future:
These insights are helping hospitals:
ER high utilizers have been defined as "people of modest means and poor health who go in and out of emergency rooms day after day, their fundamental health issues rarely resolved, at a tremendous and ever growing cost to hospitals, municipalities and taxpayers." These individuals are largely suffering from chronic conditions and live in an area with restricted access to outpatient care facilities. Emergency departments become the primary care provider for many who are unable to access and/or lack the resources needed to secure a regular primary care physician.
The impact to the system is significant. ER high utilizers and the resulting avoidable ER visits translate into increased resource constraints, financial waste, and overcrowding. The Emergency department is an expensive place to deliver care - especially when the care administered is for non-emergency occurrences. According to the New England Healthcare Institute (NEHI), approximately $32B is wasted each year on avoidable ER visits.
The focus on these patients is primarily driven by the need to cut healthcare cost. While ER high utilizers are seen as a major contributor to waste, the equation isn't that straight forward. Getting these patients to use primary care pathways is a start, but it doesn't address clinical and social complexity that is often driving what are deemed avoidable ER visits. High utilizer interventions have to be tailored and account for the nuances within the population. For example, mental health and substance-abuse are contributing factors to avoidable ER visits and are correlated with high-levels of spend/resource allocation. The lack of mental health resources is a major underlying driver for these visits and one that has been well documented.
As value-based models of care and reimbursement that drive accountability both inside and outside the four walls of the hospital gain traction, more focus will be placed on preventing avoidable ER visits and implementing interventions within the community. Finding the right care environment that drives better health outcomes will ultimately reduce waste across the system, not just within the ER. And while ER high utilizers are a complex patient cohort, the right levels of care coordination and community-based interventions can help reduce the burden that they place on the hospital while improving the overall health of individual patients.
Find out how Jvion's solution can help better manage your ER costs. Contact us at firstname.lastname@example.org.
-Jamieson D. The Treatment of Kenny Farnsworth. Washington Post Magazine 2009.
- Emergency Department Overuse: Providing the Wrong Care at the Wrong Time. Cambridge, MA: New England Healthcare Institute; 2008
- Frequent Users of the ER Fact Sheet; American College of Emergency Physicians.