RD490 - Annual Report: Emergency Department Care Coordination Program – November 1, 2017

Executive Summary:

Five percent of patients account for nearly 25 percent of all Emergency Department (ED) visits in the United States. These high utilizers of ED services typically do not receive the right care, with the right provider, at the right time – or at the right price. High utilizers often present to the ED with chronic health concerns that have gone untreated and unmanaged. The Emergency Department Care Coordination (EDCC) Program aims to improve individuals’ health by providing information which assists providers in targeting their care and connecting them to primary caregivers. The goal of the EDCC Program is to reduce ED visits and decrease hospital costs, while providing the best care in the best setting for the patient. Ultimately, a patient’s relationship with their community-based, primary care providers will be supported and strengthened, leading to improved adherence to treatment recommendations and continuity of care.

In multiple states where ED care was coordinated through encounter alerts and care plan programs, similar to what is planned for the EDCC Program for Virginia, ED visits by high utilizers declined, managed care costs declined, prescriptions of controlled substances declined, and quality of care improved. The State of Washington saw an 11 percent decline in the number of ED visits by high utilizers (defined as 5 or more visits per year) and a 14 percent decline in ED visits with a low acuity diagnosis in the first year of the “ER is for Emergencies" program. This program combined the development of care plans, the implementation of the Emergency Department Information Exchange, participation in prescription drug monitoring, and patient education on appropriate use of the ED.1 In Oregon, when an ED care coordination program was established with encounter alerts and coordinated care plans, ED visits by high utilizers decreased 10 percent.2 In Indiana, during a six-month trial of an ED alerts program at nine hospitals, one managed health plan saw significant savings. “The shift from ED to primary care visits that occurred during the pilot test saved the health plan an estimated $2 to $4 million over the 6-month period."3 The State of Washington also saw significant savings after implementing the “ER is for Emergencies" program. Medicaid costs fell by nearly $34 million in the first year.