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
Benefits
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
