Too often, patients visit the emergency room (ER) for minor, primary-care treatable conditions such as upper respiratory infections and urinary tract infections—and even preventive care. For many people, the ER is the first place they think of to go—even if the condition is not an emergency. When patients with non-emergent conditions visit the ER, it drives up healthcare costs for themselves and their employers—and keeps healthcare workers from focusing on those who really need emergency care. The good news is that with a strong care management program, self-insured employers can decrease ER utilization, cutting costs and improving healthcare outcomes at the same time.

What to Know About the Emergency Room (ER)

Is an ER Visit Necessary?

Visiting the emergency room is always an expensive decision. When a health plan participant visits the ER, there are hefty costs for both the participant and the self-insured employer. In many cases, those ER visits are preventable and the same care could have been provided in other, less costly settings. For example, one analysis showed that an estimated $8.3 billion is spent each year on emergency department care that could be provided in another location.

Why People Overuse the ER

Many patients use the ER because it’s more convenient than making an appointment and waiting to see their primary care doctor. There may be a long wait once they get to the ER, but if they’re willing to wait, they can see the doctor today.

People also overuse the ER because they may believe they have an emergency when their condition really isn’t urgent. As the study above noted, about 60% of ER visits by people with insurance could have been handled in other settings, meaning the needs really weren’t urgent. This shows that many individuals lack the health literacy they need to make an informed decision about whether a particular condition requires emergency care.

Care Management Is the Solution

Self-insured plans can capitalize on the cost-saving results of such education by partnering with a superior care management solution. Rather than spending unnecessary funds on unwarranted ER visits, these plans utilize care coordinators to help participants make more informed decisions about where and when to seek care.

When plan participants are closely connected with their care teams and accustomed to contacting them with questions, and know their care teams are available around the clock, participants will naturally contact their care managers before visiting the ER in non-emergent situations. For many injuries and illnesses that may seem like emergencies, there are other, less expensive options for accessing care—and a superior care management team shares those with participants, helping them make the right decision for their situation.

Lucent Health’s care management solution powered by Narus focuses on providing the type of care management that helps health plan participants make smarter, cost-saving decisions about visiting the ER and other healthcare choices. The use of continuous data analytics provides ongoing insights that lead to better care management, ensuring that participants receive the right care, at the right cost, at the right time.

A recent third-party analysis showed that over three years, the cohort of patients managed by Narus Health—which Lucent Health acquired in 2019—experienced a greater reduction in ER visits than the group not managed by Narus. The non-managed group reduced ER visits by 19.5% from 2019 to 2020, while the Narus-managed group reduced ER visits by 29.5% over the same time period.

Lucent Health’s recent independent audit reveals that successfully engaging members and walking with them through their healthcare journey helps avert or mitigate health crises, resulting in significant savings for both members and employers. Learn more in our e-book, “Top-Notch Care Management Is Crucial for Managing Healthcare Costs.”