|By Bowman Hitchens
There are a lot of innovations happening in healthcare. Prioritizing them can be challenging, and it can be easy to say, “I’ll look at that once I’m done implementing X, Y or Z.” Here are five questions to help define and hopefully prioritize Population Emergency Medicine.
What is Population Emergency Medicine?
Population Emergency Medicine is a direct contract with an emergency medicine practice aimed at improving access to care, improving health outcomes, and reducing wasted healthcare spend for large populations.
How does emergency medicine impact the total cost of care?
If you take the cost of emergency medicine at face value, you only see a fraction of its impact. When you look at claims data like we do (combining emergency physician, actuary, and value-based solution provider perspectives) the opportunity to significantly improve member health outcomes and reduce costs is easier to see.
The number of emergency room visits where a hospital setting was non-critical can be as high as 2/3 with costs as high as 10-12 times more than alternative sites of care. Hidden within these non-critical visits exist examples of the “messy middle” of healthcare, where members are accessing care in a dysfunctional way and health outcome improvements are not proportional to the costs.
How do inadvertent ER outcomes create waste?
The ER physician is a powerful resource when it comes to diagnosis and is critical for high-acuity concerns. The challenge is that during non-critical visits, a traditional hospital setting doesn’t afford the physician the time and resources to do what might be needed for the member.
A common example is members with repeat emergency room visits. Each visit seems unrelated, but there are often underlying mental health and undiagnosed chronic care needs driving the frequent visits. To the members, visiting the emergency room is the right thing to do, so without input they repeat the pattern.
Another example is members with multiple comorbidities being referred to an emergency room. The medical concern often does not need a hospital setting, but now they have been seen at the emergency room, admitted for observation, and referred to non-value-based downstream providers.
Each concern can benefit from the keen diagnosis of an ER physician, but the outcomes inadvertently put additional burdens on the patient.
Can we reduce the Burden of Treatment?
Yes. The Burden of Treatment (the time, money, focus, and guidance needed to successfully navigate healthcare) often falls on the member. For an already struggling member, it is often too much, so they repeat bad habits or become non-compliant with their care.
The role of Population Emergency Medicine then is threefold:
1.Provide a valued alternative to avoid unnecessary emergency room visits
2.Identify dysfunction and be hands-on with the member through their journey
3.Address the Burden of Treatment with the member
Successfully fulfilling these roles creates trusted relationships that drive increased treatment compliance and maximize the utilization of benefit plan programs, through referrals and orchestration.
How is the impact of Population Emergency Medicine measured?
We believe creating true impact starts with at-risk contracting. We put our fees at risk (up to and including full-risk), ensuring accountability to the savings we create.
Another clear measure is reduced ER utilization. As the only value-based Population Emergency Medicine solution provider with an outcomes validation, Crucialist demonstrated a 22.2% reduction in ER utilization in an 18-month period (outperforming the 2019 to 2020 COVID ER reductions by 39.9%).
Other impacts can be seen in patient stories, healthcare outcomes, and member satisfaction. We have first-hand experience with these and proudly reported a 97% satisfaction rating for 2021. I encourage you to learn more about Crucialist or reach out here.
 The High Cost of Avoidable Hospital Emergency Department Visits | UnitedHealth Group
 Trends in the Utilization of Emergency Department Services, 2009-2018| U.S. Department of Health and Human Services