Many of the emergency department visits that MaineHealth ACO beneficiaries make each year are avoidable. Often, they’re for acute but mild health problems that could have been resolved at a primary care office or were a result of poorly controlled chronic conditions. Such visits can be stressful for patients since they often experience a long wait before they see a provider and a large bill afterward.
Jean Harris (L) had 9 admissions and 3 ED visits in the 12 months before she enrolled in the REDUCE Project’s care management intervention. With help from ACO Care Manager Michelle Tarr, RN, (R), she’s had no admissions or ED visits since.
In 2019, the ACO’s REDUCE* workgroup launched two projects to help patients avoid emergency department (ED) visits. Like all the ACO’s priority workgroups, the REDUCE group’s membership is diverse. It includes experts in data analysis, care management, communications and performance improvement, among other domains. The interdisciplinary nature of the group led to two very different approaches to reducing ED utilization, one focused on individual patients and the other on communicating to a mass audience.
Extracted from Arcadia 20200514, represents claims received through April 2019, Total Population ACO risk-lives
The patient-focused project responded to an opportunity to prospectively intervene with patients using a newly-developed data analytic capability. Research suggested that patients at risk for ED utilization would reduce that risk if they participated in intensive care management. The workgroup was encouraged that the ACO had the care management resources to launch such an intervention. But how to identify the patients who would benefit the most? Data scientist members of the workgroup had an answer: use the ACO’s new predictive analytics tool. With two key skills in place — ED use prediction and care management — a meaningful intervention was in reach. The team began the project modestly, partnering with several primary care practices and providers to identify eligible patients and launch the intervention. The team then incorporated feedback from this small group of providers to refine and expand the intervention to more than 200 patients by the end of 2019.
As care managers began their one-on-one work with patients, members of the REDUCE team with communications and performance improvement expertise piloted the second project, the Where to Go for Care patient education campaign. The campaign centered around creating and distributing an infographic to help patients determine the most appropriate site of care for their particular situation, based on convenience, cost and medical condition. It compared the emergency department to three alternatives: the primary care office, walk-in clinic and urgent care center. After extensive review by providers, patients and content experts, the team distributed the infographic to practices across the ACO, allowing health systems to adapt it to reflect the care options available in their regions. In addition to creating regional versions, the team translated it into six languages commonly spoken by new Mainers and also produced a short video version for lower literacy audiences. Practices posted the infographic in their waiting rooms, displayed it using electronic signage and handed it out to patients. Other audiences saw it on the “patients and visitors” page of the MaineHealth website and viewed the video on social media. We estimate that the infographic and video reached 30,000 in 2019.
Thanks to many factors, including efforts like these and a MaineHealth system-wide focus on cutting avoidable emergency department utilization, we saw a 6.3 percent reduction in emergency room visits among ACO beneficiaries in 2019.
*Reducing Emergency Department Utilization – a Collaborative Effort