Avoidable ER visits reduction

Medicaid Health Plan

Business problem

  • Year over year ER visits and associated costs were increasing
  • Health plan leaders did not know what type of members were visiting the ER and why
  • No insights about what could be done to reduce unnecessary ER visits 
  • No insights about member personas/profiles associated with unnecessary ER visits, preventing redirection to alternate care

The solution



  • Health plan leaders could clearly understand the historical trends for avoidable and non-avoidable ER visits, costs and population management opportunities
  • Creation of distinct member segments based on demographic, utilization, clinical and chronic disease characteristics allowed health plan leaders to understand gaps in care and pursue options for cost-effective alternative care
  • Predictive models enabling identification of future ER visits and future ER patients allowed clinical teams to create targeted intervention strategies to reduce ER utilization
Avoidable visit identification
Case Studies

You may also like

View All

Provider Directory Automation

Reduction in processing time

View Case Study

Enterprise Analytics Platform

Savings opportunity

View Case Study