Emergency Room High Utilizers
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 areas 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 costs. While ER high utilizers are seen as a major contributor to waste, the equation isn't straight forward. Getting these patients to use primary care pathways is a start, but it doesn't address clinical and social complexity 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 redefine accountability and performance both inside and outside of the hospital gain industry traction, more focus will be placed on preventing avoidable ER visits and implementing interventions within the community. Finding the right care environment that leads to 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.
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