ER impact: 4 ways to help employers manage ER utilization
Rising ER visits cost employers and members. Learn how access to primary care, virtual options and proactive navigation can reduce avoidable ER use.
Emergency department utilization is rising — and with it, a significant source of avoidable cost for employers. Emergent visits rose 2% from 2024 to 2025, according to the UnitedHealthcare 2026 Health Trends Report.1 By 2035, overall ER visits are projected to climb 5%, driven largely by sicker patients and delays in getting care.2 The trend is broadening, too: Millennials now visit the ER more frequently than any other generation, and Gen Z posted a 5.2% increase in ER visits while remaining the least likely generation to use primary care.1
The ER plays an essential role when the situation truly demands it, but that role often comes at a steep cost relative to other care settings. Knowing when the ER is — and isn’t — the right place to go can make a meaningful difference for both employers and members, especially considering the average trip to the ER costs 14x more than a trip to the urgent care, according to UnitedHealthcare data.3
The good news: These patterns are manageable, and the savings are measurable. According to an independent actuarial analysis by Milliman, UnitedHealthcare was found to deliver a more than 11% lower total cost of care compared to national benchmarks, including 9.3% lower-than-average outpatient costs and 13.8% lower-than-average inpatient costs.4
Those category-level savings are driven in part by individual redirections. For instance, when UnitedHealthcare used claims and demographic data to identify and reach out to members who were deemed most likely to use the ER for non-emergent care, the result was that an estimated 3,100 ER visits were redirected, generating roughly $7.6M in cost savings.5
For employers, the takeaway is that ER redirection isn’t an isolated cost-cutting tactic. It’s one of the outpatient cost levers that contribute to a measurable, benchmarked advantage in total cost of care.
1. Educate employees about appropriate ER usage
Employees end up in the ER for all sorts of reasons. Some default to it out of habit, assuming it’s the fastest way to get treated when something feels urgent. Others land there because they’re unclear on what their plan covers, expect shorter wait times or simply don’t have convenient alternatives nearby.
ER use also tends to run higher among employees with low health care literacy — those who aren’t sure how to access or use their benefits. In fact, generally healthy people with low health care literacy were 3.7x more likely to visit the ER than those with high health care knowledge.6 That’s why building employees’ understanding of their benefits can be just as important as the benefits themselves when it comes to managing cost.
The UnitedHealthcare Health Activation Index® (HAI®) tool helps employers see the payoff of that education in concrete terms. Using a single score, the HAI tool measures how effectively employees and their covered family members are navigating care and making evidence-based health choices — the very behaviors that benefits education aims to build. The impact is significant: Higher HAI scores are associated with up to 60% lower health care costs,7 as well as roughly 60% fewer inpatient admissions and 60%–70% fewer ER visits per 1,000 high-risk members.8 In other words, when employees better understand and engage with their benefits, it shows up in their health decisions — and in an employer’s bottom line.
Open enrollment is a natural moment to deliver that education, since employees are already thinking through their plan choices. But it shouldn’t be the only occasion. Benefits education is most effective when it continues throughout the plan year and surfaces right when health events arise.
Employers can make that happen by carving out time in employee meetings or email communications to cover topics like the difference between network and out-of-network providers, how prior authorizations can shed light on upcoming costs and where to go for care based on different health needs.
Other best practices 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. Pair ER education with out-of-network cost management
ER visits are also a frequent source of surprise out-of-network bills— which is why out-of-network management compounds the savings from ER redirection. The Milliman analysis found that UnitedHealthcare clients with Naviguard® as their out-of-network management program saw even higher savings, with their total cost of care being more than 13% lower than national benchmarks (up to 18% in certain regions), since the program is designed to resolve and reduce out-of-network bills.4
Reducing non-emergent ER use and managing out-of-network billing are complementary levers for employers. Together, they can have a greater impact on total cost of care than either approach alone.
3. Ensure employees have adequate access to alternative care options
One of the clearest levers for reversing rising ER utilization is access: A recent all-payer claims analysis found that every 10 additional primary care visits per 1,000 people were associated with 7 fewer ER visits per 1,000.9
Employers may want encourage employees to foster a lasting relationship with a primary care provider (PCP) through rewards programs or by highlighting benefits like low- to no-cost preventive care. The payoff is measurable: Patients with 3 or more PCP visits per year had significantly lower odds of non-urgent emergency department visits.10 A PCP can also serve as a trusted touchpoint for “where should I go for care,” catching concerns early and helping employees perhaps avoid an ER visit and the subsequent expensive claims.
But access isn’t only about clinician availability — it’s about the conditions that shape whether people seek care in the right place at all. Nonmedical social drivers of health (SDOH) like economic stability, housing, transportation and neighborhood context strongly influence care-seeking decisions. Employers that help surface and address these needs — often through partnership with community resources—are tackling a root cause of avoidable utilization. And where local care options are thin, employers can close the gap with on-demand and virtual care.
4. Choose a carrier that helps support members in navigating to appropriate care settings
By analyzing member claims data, with the support of AI capabilities, UnitedHealthcare Advocates can proactively identify at-risk members with complex conditions and provide 1-on-1 support — directing them to an appropriate site of care for their needs or enrolling them in a care management program that may prevent an ER visit altogether.
Predictive models are central to this work. Using diagnosis and claims history, prior ER utilization, demographics and plan information, UnitedHealthcare assigns each member a score for their likelihood of using the ER for non-emergent care. These scores enable UnitedHealthcare to identify high-risk members for targeted communications campaigns.
The approach reflects a broader, evidence-backed shift toward proactive intervention: A 2025 propensity-matched study of a primary care model that combined monthly screenings, medication oversight and real-time admission-discharge-transfer (ADT) alerts delivered a 6.9:1 return on investment and significant reductions in both ER visits and hospital admissions within 60 days.11
UnitedHealthcare extends this strategy to the moments after an ER visit, too. Real-time ADT alerts trigger outreach from a registered nurse shortly after discharge to answer questions about post-visit care, connect the member with a PCP or specialist for follow-up and help them understand alternative sites of care for future needs. This helps reinforce the right care-setting habits before the next health issue arises, potentially lowering costs as well.
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