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As an employer are you educating your employees about the appropriate use of the Emergency Room, Urgent Care and Telemedicine?

One in five Americans will visit the Emergency Room (ER) at least once a year. Between one-third and one-half of all ER visits are for non-urgent matters.

Many conditions can be treated at Urgent Care centers. A recent review of the top 100 diagnosis codes from a self-insured employer revealed that 83 percent of them were in the top 100 diagnoses seen at a nearby urgent care center.

Unnecessary and inappropriate use of the ER causes multiple systemic issues and wastes scarce resources. The average cost for an ER visit is $1400 — compared to $125 for an urgent care visit.

Chronic conditions — which affect 45 percent of Americans — account for 75 percent of health care expenditures in the US. Diabetes, heart disease, asthma, and other chronic illnesses are also responsible for a large portion of ER visits. Asthma alone precipitated 1.8 million ER visits in 2004.  The ER visits resulting from unmanaged chronic conditions are avoidable. Proactive disease management, effective patient and caregiver education and simple lifestyle changes, can reduce ER usage for this group by up to 69%.

Appropriate use of the ER could save the U.S. healthcare system more than $18 billion a year. Patients with avoidable or non-urgent conditions who use urgent care centers, primary care physicians, or a telemedicine service can contribute significantly to creating a sustainable healthcare system.

How do you divert your employees to Urgent Care or Telemedicine?

An effective ER diversion program begins and ends with employee education. If you, as an employer, are serious about reducing your health care spend you need to think about the following;

Education Campaigns: Educational messaging creates an awareness of cost consciousness, reinforcing how to use urgent care, emergency room care, telemedicine and primary care. Campaigns leverage long-standing trusted relationships in order to have the greatest impact in changing the behavior of inappropriate ER use. If you partner with a Telemedicine service make sure your employees know how to use this benefit – provide examples, maybe a wallet-sized card with the 1-800 number, a list of appropriate ailments etc. Provide an online map to the nearest Urgent Care.

Member Engagement through Incentives: It may take the use of incentives to encourage members to change their behavior about the correct use of the ER. To reinforce behavior change, a great way to keep people engaged is to provide incentives to employees who seek appropriate care, including gift cards, coupons, and vouchers for dining, entertainment, and other goods and services.

The use of good data is the key to success.

It is essential to use Data to define the Initiatives: Use data analytics to establish a baseline reading of ER, Urgent Care, Telemedicine and primary care use. This information guides initiatives revealing the hotspots for intervention. Your data analytics should measure the impact of initiatives and allow for adjustments as needed. Use claims analysis to alert employees about a previous ER visit and show them the financial advantage of that visit when compared to using Urgent Care or Telemedicine. The employee will be forever grateful – particularly if they are responsible for large ‘out of pocket’ costs.

Take the time to explain all the benefits to your employees

Employees who manage their health and seek Urgent Care treatment instead of ER services (when appropriate) can expect to enjoy several benefits:

·      Save Time: The average wait time in urgent care centers is a door through door time of 45 minutes. Walk-in patients receive high-quality treatment quickly and efficiently. Very often issues can be addressed via Telemedicine in less than 10 minutes.

·      Save Money: Compare the $140 price tag of an urgent care visit to the $1400 price tag of the average ER visit. Even if a member’s insurance covers these costs completely, members learn that inappropriate use of the ER drives up the cost of healthcare and inevitably the consumer will pay for it. Employers are known to cover the cost of a Telemedicine consult 100%.

·      Reduce stress: Using an urgent care center when an illness or injury strike relieves the stress of handling an unscheduled crisis. When families have easy access to affordable, high-quality and convenient care when they need it, they go home happier and satisfied.

The Obeo Health Organizer module can help you reduce your ER costs – take a test drive of this module today.

The Risks of the 15-Minute Doctor’s Appointment

How would you react if you sent your sputtering car to the auto mechanic, and they stopped trying to diagnose the problem after 15 minutes? You would probably revolt if they told you that your time was up and gave back the keys.

Yet in medicine, it’s common for practices to schedule patient visits in 15-minute increments — often for established patients with less complex needs. Physicians face pressure to mind the clock while they examine you.

That’s not to say that your physician “clocks out” as soon as your 1 p.m. appointment hits 1:15, or that all appointments last that long. What it does mean is that patients and doctors may be deprived of the opportunity for more meaningful discussions about the underlying causes of their problems and plans to improve them. A woman in her 50s who presents with high blood pressure and obesity might need medicine. But a longer conversation about the stresses of being the primary caregiver to her father, who has Alzheimer’s, could help provide strategies to help her look after herself.

When you see a new patient every quarter hour, there is often scant time to get to these root causes, to make accurate diagnoses, and develop the best treatment plans. And there is the danger that you miss a major diagnosis altogether.

The 15-minute appointment arose not out of evidence that it improves patient outcomes but out of production pressures — both the need to meet patient demand and to see enough patients to stay profitable.

Unpopular among patients, these production pressures have few fans among physicians either. A Mayo Clinic report stated that 54 percent of physicians meet the criteria for burnout in 2014 — up nearly 10 percent from three years earlier. Running on a treadmill all day in 15-minute sprints likely contributes to this phenomenon. Onerous documentation requirements and other pressures don’t help, either.

Some patient problems could be solved in 5, 10 or 15 minutes, but others cannot. What if health care trusted its physicians enough to take the time they need with patients and no more — and then monitored and paid for results? Could we realize better care while reducing costs, because patients are getting the right diagnosis sooner, and not coming back after their problem has been missed and their condition has worsened?

It’s not clear whether alternative payment models will achieve this. Concierge practices, in which patients pay a hefty annual fee in exchange for greater access to their physicians, may work well for those who can afford it. While this model is beyond the financial reach of many, a related model called direct primary care — or “concierge care for the masses” — is more accessible. Patients pay a monthly fee of anywhere from $25 to $85 to cover their primary care services, according to a Health Affairs report in December, and are encouraged to have insurance to cover more serious health issues. Patients and physicians might have 45 minutes to spend in an appointment. Because direct primary care usually does not bill insurance, it results in less checking boxes and more conversation.

A criticism of these models is that they may exacerbate the larger physician shortage, because physicians are responsible for significantly fewer patients than in a typical practice. Yet we need to evaluate their impact and see if their lessons might help us reclaim the patient-physician encounter.

This post first appeared in The Wall Street Journal’s blog, The Experts.