Why Steering Members Away from the Emergency Room Helps Address Care Gaps

So often, we forget how expensive, time-consuming, and emotionally draining emergency room visits are for members seeking general medicine. According to the CDC, Medicaid members had the highest emergency department visit rates, averaging 97 visits per 100 people;1 and in 2019 alone, it was estimated that 151 million emergency room visits occurred in the United States, with 22% of adults visiting the emergency department in the past 12 months.2 This is an evident and systemic problem that can be solved as “71 percent of emergency department visits could be treated safely in an urgent care clinic or primary care setting or did not require urgent care.”3

Despite this being such a pervasive issue, mobile health engagement is a clear and direct solution to this problem. Prioritizing continuous support through digital communication to reduce the number of emergency department revisits is one way to counteract this issue for your members.

After receiving treatment in the emergency room, it is crucial and always recommended to follow up with a primary care provider. Often, members, especially Medicaid members, will not schedule a timely primary care appointment due to a lack of access to primary care.4 One way to counter this lack of preventative care is through prompt and clear digital engagement with members. Reminding your members to schedule follow-up appointments through text as well as providing primary care locations and contact information to make scheduling and going to these appointments as convenient as possible for your members is an effective outcome of mobile health engagement.

Providing your members with the resources and awareness of other possible means of healthcare through their phones will not only reduce the amount of time and money spent in emergency departments, but will also assess the many care gaps and lack of connection to primary care and preventative health services that your members may not be experiencing.

In addition to follow-up appointment scheduling assistance and reminders, there are many other facets to mobile health engagement that can help reduce your members’ visits to the ER. Some examples include providing 24/7 access to a non-emergency care team via text messaging or phone number, identifying members’ social determinants of health, and providing information and tools to address common health disparities within their community.

Having a mobile engagement and education channel that informs members of the many types of primary and preventative care they have access to if a medical issue arises builds trust and connection between you and your members while reducing the risk of adverse health outcomes to outstanding emergency room visits.


References

1Products – Data Briefs – Number 401 – March 2021. (2022).

2Products – Data Briefs – Number 434 – March 2022. (2022).

3Rigsby, A. (2018, August 14). Emergency Department Costs and Telehealth – Encounter Telehealth. Encounter Telehealth.

4Kim, H., McConnell, K. J., & Sun, B. C. (2017). Comparing Emergency Department Use Among Medicaid and Commercial Patients Using All-Payer All-Claims Data. Population Health Management, 20(4), 271–277.