The ER impact: 3 strategies to help employers manage ER utilization
Many people visit the emergency room when health crises strike, but recognizing when to choose a different site of care may help reduce costs for employees and their employers.
Each year, the health care system bears a $47B burden from individuals who seek care in ERs for conditions that could be treated elsewhere.¹ This misuse is often a result of misunderstanding benefits or confusion over which care setting is best for specific situations.1
When used appropriately, ER visits serve a critical function within the health care system. However, ERs are pricier than other care options, so it’s important for members to know when it’s the right place to go — and when it’s not.
According to UnitedHealthcare data,2 the average combined costs for employers and employees by site of care are: $2,722 for an ER visit, $184 for an urgent care visit and $54 for a virtual visit. ER visits are the costliest site of care by far, with an average visit running employers $1,800 and employees $922 in out-of-pocket costs.
Employers looking to reduce those costs may want to adopt strategies that can help, such as:
1. Providing employee education
There are many reasons why employees may end up choosing to visit the ER. Employees may end up going to the ER as a default, assuming they can receive prompt treatment in times of need. Or they might turn to ERs if they have a limited understanding of their benefits coverage, if they think they’ll receive quicker treatment compared to a primary care provider (PCP) appointment or if they have insufficient access to alternative health care options nearby.
ER use may also be more common for employees who have low health care literacy — lacking understanding about how to access and use their health care benefits.1 In fact, generally healthy people with low health care literacy are 3 times more likely to visit the ER than those with high health care literacy.1 That’s why boosting health care literacy may be critical to helping employees maximize their benefits and manage costs.
While open enrollment provides employers with an opportunity to communicate health care information when they are making plan decisions, it’s also important to offer benefits education throughout the plan year and as health events arise.
Employers can do that by dedicating time to benefits education in all-employee meetings or email communications that cover topics such as the differences between network and out-of-network providers, how prior authorizations can give insight into upcoming costs and where to go for care based on different health needs.
Other best practices for engaging employees with their benefits include:
- Varying communications based on employee preferences
- Listening to employee feedback about their experiences
- Reviewing claims data to tailor messaging to certain segments
- Aligning communications to current events or timely topics
- Diversifying education tactics to keep things interesting
2. Addressing social drivers of health
Employers may start to see reduced ER utilization when they address SDOH within their workforces. SDOH are community-level factors that shape a person’s life and can be identified by the health care system and addressed in collaboration with community resources. They are nonmedical factors, such as economic stability, education and neighborhoods, which influence health and health-seeking decisions.
In geographic areas where care options are limited, employers can adopt a network strategy that includes a robust virtual network or access to on-demand care options. Employers also can encourage employees to establish an in-person or virtual relationship with a PCP through wellness incentive programs that provide low- to no-cost preventive screenings. PCPs can also serve as a touchpoint for where to go for care.
For example, the UHC Hub™ at UnitedHealthcare is a network of vendors that complement existing health care solutions. The Hub consolidates third-party vendors — like Brightside, which provides members with financial help, and Kaia Health, which offers digital physical therapy that members can access wherever they are — to make it easier for employers to evaluate, choose and engage with health care solutions that fit the unique needs of their workforces.
And for employees who may be struggling financially, learning more about the economic value of their health benefits may help alleviate some of the stress that comes from worrying about health care costs. For instance, UnitedHealthcare offers several vital medications at no cost to members and many preventive screenings with no copay.
3. Choosing a carrier that prioritizes advocacy
With one of the world’s largest databases of health care information, second only to the Centers for Medicare and Medicaid Services, UnitedHealthcare is uniquely positioned to identify opportunities to drive engagement and more effective health care utilization within an employer’s population. For instance, by analyzing member claim data, Advocates can proactively identify at-risk members with complex conditions who may seek emergency care.
As part of the UnitedHealthcare Complex Care Concierge program, these members may be matched to a dedicated Care Advisor who provides 1-on-1, on-demand support to help them understand and better utilize their benefits. That support helps drive more than just a better member experience: Members enrolled in Complex Care Concierge reduced ER visits by 10% and claims by 15%.3
UnitedHealthcare also has a post-ER-visit strategy that includes Advocates who reach out after a member seeks care in the ER. Real-time Admit Discharge Transfer (ADT) alerts facilitate the outreach of a registered nurse within a short time of discharge, who can help answer questions about postvisit care, connect the member to a PCP or specialist for follow up and help them understand other site-of-care options for future health needs.
UnitedHealthcare, often in collaboration with its employer clients, also conducts email campaigns that target members who have recently visited the ER, highlighting the best sites of care for different conditions, including when it’s best to go to the ER, an urgent care center or to have a virtual visit. These ER redirection campaigns have saved a combined $4.9M in health care costs.4
Knowing where to go for care may lower the total cost of care
A third-party study reveals the UnitedHealthcare multi-pronged approach to lowering the cost of health care for members exceeds the industry average by around 10%.5
Read the study to see how site-of-care redirection, inpatient management and preventive care utilization can make a big difference to employees and their employers.
