By Mike Ipekdijan, CarePort
Hospital emergency department overutilization is costly for providers and patients. More than one-third of all ED visits are avoidable, and if patients were instead diverted to a lower level of care the U.S. healthcare system could save more than $18 billion per year. Despite the many drivers for unnecessary ED use, there is a tremendous opportunity for providers to improve care coordination and achieve ED optimization.
Providers often lack visibility into a patient’s status as he or she moves through the care continuum, making it nearly impossible to divert unnecessary ED admissions and ensure patients receive the most appropriate level of care. To reduce ED utilization, minimize observation stays, and maximize ED throughput – thus reducing costs and improving quality of care – provider organizations must deploy care coordination technologies.
How Care Coordination Technology Should, And Can, Enable ED Optimization
- Monitor patient transitions across the care continuum
In the absence of care coordination programs, providers face patient movement identification challenges. A patient’s care team – including care coordinators, case managers, primary care physicians, and post-acute providers – often lack sufficient visibility into patient transitions across the care continuum and receive no notifications when changes in a patient’s care journey occur. However, provider organizations are increasingly investing in technology solutions to improve communication between – and care coordination among – healthcare providers to address such challenges.
Real-time patient event notifications give providers increased visibility into patient transitions across the care continuum, alerting them when a patient presents at the emergency department. Timely alerts, which include utilization history and risk flags for high ED utilizers, equip providers with necessary clinical context to avoid unnecessary ED admissions. It is essential that providers have access to a patient’s full utilization history, and that it is presented in a digestible way. Armed with this information, providers can intervene and redirect patients to the appropriate level of care before the patient is admitted for an acute observation stay. Care coordination technologies can enable a more comprehensive view of transitions of care, streamline ED throughput, and reduce the likelihood that patients will return to the hospital.
- Identify and engage with high ED utilizers and at-risk patients
It is critical that providers have visibility into historical patient data, and that it is accessible in an actionable, digestible way. Aggregating a patient’s utilization history enables care coordination platforms to generate clinical and patient risk indicators to inform providers of complex patient cases. Risk indicators can help identify at-risk patients and high ED utilizers – patients who present to the ED multiple times in one year – to better coordinate care for these populations. There is a lack of visibility into when patients in risk-based programs present to the ED, but providers must have this information, as providers are particularly at-risk financially for these patients.
For example, if a provider can see that a patient has visited multiple EDs in a matter of days, this may indicate that he or she needs a more robust care plan or additional community services. Care coordinators must utilize solutions that allow them to identify frequent ED utilizers and at-risk populations and intervene to ensure these patients receive the best care plan for their specific needs.
- Prevent readmissions from post-acute care
According to JAMA, on average, 23 percent of patients are readmitted from a skilled nursing facility (SNF) to the hospital within 30 days. Hospital readmissions from post-acute facilities may indicate care coordination inefficiencies, such as a mismatch between patient needs and post-acute care facility resources, or a shortcoming in the patient’s transition from post-acute facility back to the community.
With the right care coordination programs in place, providers can reduce the likelihood that an emergency visit will turn into an inpatient stay. Providers can see a patient’s chief complaint and, with full visibility into a patient’s history, determine whether there was a recent SNF stay or homehealth service, as well as past diagnoses or risk flags. When possible, a patient can be intercepted and diverted back to the post-acute facility.
Care coordination technologies can surface the complete picture of a patient’s care journey to help providers, and ensure patients receive the appropriate level of care when they need it – potentially reducing overutilization of the emergency department. As a result, providers experience improved ED throughput, fewer patient readmissions, reduced costs for value-based patients, and improved long-term financial performance. Optimizing care coordination is the key to reducing unnecessary ED admissions – and the costs associated with them – while helping EDs operate as intended: for emergencies.
About The Author
Mike Ipekdijan is Director of Customer Success at CarePort.