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Reduce Preventable ER Visits Strategic Plan
- 1. Strategic Plan Prepared By: Pramila Viswanathan, MD., MBA
- 2. GOAL Decrease the use of emergency rooms for non-emergency treatment Decrease preventable ER visits, those with diagnosis meeting the Appendix F criteria
- 3. OBJECTIVES To help health plan members get better quality of care Reduce the cost of healthcare provided
- 4. Strategies in Support of the Goals and Objectives
- 5. Analytics Education Marketing Physician /Staff outreach Health Plan
- 6. Analytics
- 7. Analytics: Identify members with avoidable ER visits (frequent flyers) from the claims data of the last 2 years, classify as low, medium and high utilizers Identify population: 1. Chronic disease 2. Narcotic scripts 3. Demographics Identify top 10 diagnosis (appendix F) Identifying providers of care with high ER rate
- 8. Survey: Frequent flyer members- Reason for their ER preference over office visits/urgent care centers Barriers for their primary care use – communication, lack of knowledge about the alternatives to care, after office hours…. What one thing had they had knowledge of, would have helped them decide to see their primary care provider/urgent care rather than ER Providers of care- What was done different among those who had low ER utilization What characteristics do they attribute their high ER utilization rate
- 9. Education
- 10. Patient/Members Help them understand when to use ER, as ER lacks important information from their medical history Educate about primary care and preventative care Web based resources Access to Nurse triage line 24/7 Publication “Health wise” handbook to all members who used ER for ambulatory sensitive condition, with access to online version of the handbook, which includes an interactive symptom checker
- 11. Triage Nurses/Call center About outreach programs in the community, availability of care coordinators, CM… to enable them to connect directly to their care coordinators/CM 24/7 About after office hours urgent care center, alternative care centers in the community, locations and contact information… RN triage and actually prescribing medications for certain complaints eg: UTI, following the nursing guidelines, provided the IL state nursing practice act allows for the same
- 12. ER Maintaining real time ER registry and educating the staff on notifying the PCP’s of their members ER visit and outcome
- 13. Marketing Urgent care/walk-in clinics
- 14. Brochures To all their frequent flyers, send brochures with information on when to use ER with examples of situations where urgent care would be safe alternative to emergency rooms Brochures and posters distributed to physicians office with how to access help for urgent care needs fast with information about safe and effective alternatives to emergency room , with hours of operation, locations, phone numbers -
- 15. Nurse Triage 24/7 Information of the after office hour’s clinic, alternative care sites/urgent care centers, locations, phone numbers…
- 16. At ER Distribute pamphlets with contact number - triage line, location of alternative care centers, after hours clinic Outreach to frequent flyers to reconnect with their primary care provider Schedule follow up appointment on behalf of patient after ER visit
- 17. Phone members after ER visits CM/RN to call members who used ER – Find out if their needs were met and provide information of the alternative care locations, contact information of RN triage line….for future use nurse triage line urgent care centers care coordinators case managers
- 19. Multidisciplinary care team including medical director, nurse case manager, disease management care specialist, social worker meet monthly to review records of members with preventable ER visits – Whether outreach done How best to help prevent future ER use Determine the type of service that would help the patient
- 20. Outreach to those members identified to benefit from care coordination, case management, to enroll in CM/DM/medical home… Provide quarterly reports for physicians on their patients use of ER and their ER health outcomes Outreach team to call members after ER visits, f/u if their needs were met and schedule visit with primary care provider
- 21. Health Plan
- 22. Health Plan: Expand urgent care network Provide patients with resource lists (brochures) for after hours care, services offered by urgent care, list of situations what constitutes an actual emergency… at physicians offices… Local Nurse lines/ RN Triage line – guide patients to safe convenient urgent care center in the community along with information on resources to help them with other issues such as transportation,… Call members who used ER and inform about urgent care, link them with primary care provider, CM… Send publications “Health wise” handbook available in English and Spanish, to all members who visited ER