Insurers encourage less-costly ER alternatives

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Research shows that up to 20 percent of emergency room (ER) visits could be diverted to less-expensive retail sites, so health insurers like Anthem, UnitedHealth, and Kaiser Permanente are experimenting with various ways to educate their members about valid emergencies and encourage them to take advantage of less-costly alternatives for non-emergency needs, reports the Denver Post.

The incentives for health payers are clear: When an Anthem member is treated at an ER for strep throat, the insurer spends $518. If that same member is treated at an urgent-care clinic, Anthem pays $85. And if the member goes to a retail clinic like Walgreen's, Anthem pays only $35.

To help avoid unnecessary ER-related costs, Anthem buys Internet ads that pop up when a patient searches for "Anthem" and "urgent care." The ads provide a symptom checklist, locator maps for urgent and retail care, and the 24-hour nurse phone line Anthem wants patients to try before seeking medical care. The insurer also makes robo-calls to patients whose recent ER visits were "potentially avoidable" to provide them with alternatives for similar situations. The push is to "empower the member to make choices," Dr. Manish Oza, a medical director for Anthem, told the Post. "Ultimately then it's their decision how they want to spend their money."

Likewise, in Kaiser's attempt to reduce unnecessary ER visits, it found that most ER users have chronic and mental health issues that need closer coordination between primary doctors, nurses, and pharmacies. "We have seen people at the ER 55 times in a year," says Sara Tracy, Kaiser's senior manager of emergency services. The health plan is now calling those patients to a meeting with the primary doctor, a chemical-dependency counselor, and a pharmacist. "We can detox people and improve their quality of life," Tracy said. The initiative has seen patients with an average of 30 ER trips a year drop to below six visits a year.

UnitedHealthcare is also trying to prevent unnecessary ER visits by, for example, requiring a $250 copay for ER visits instead of a $25 copay for an office or urgent-care visit. The insurer also found high ER use by asthma and diabetes sufferers because of incorrect drug usage. UnitedHealth addressed this issue by eliminating some copays for diabetes or asthma visits when patients used regular offices and saw ER claims for those redirected patients drop 70 percent, reports the Post.

To learn more:
- read the Denver Post article

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