Innovation Health steps up efforts to help patients choose between ER, urgent care

Emergency room sign
Innovation Health is trying to drive home the message to its members that they can save themselves a lot of time, money and resources if they go to the right place to receive care. Image: Getty/Nils Versemann

Because Sunil Budhrani, M.D., has spent about 20 years treating patients in emergency departments, he knows all too well that many people still go to the ED for minor injuries or illnesses.

Budhrani, now the chief medical officer of Innovation Health, is “amazed” that he continues to see patients come to the ED for conditions like cuts, bruises and sore throats, he said in a recent interview.

Sunil Budhrani, M.D.

“Clearly, you come in with symptoms like that, it creates distress for everyone, because you never really want to be in the ER because you’re happy,” he said, noting that such patients often face long wait times.

Often urgent care centers or retail clinics are a better option for many acute, non-life-threatening conditions, according to Budhrani. And more than just patient satisfaction is on the line—if Americans turned to those alternative sites instead of the ED for non-emergency care, it could save $4.4 billion annually, he noted, citing a past study from Health Affairs.

That’s part of why Budhrani spent the early 2000s building out urgent care centers, then later co-founded a telemedicine company. “Much of my career has been focused on, what are the best places for people to obtain their care?” he said.

Now at Innovation Health—the joint venture between Aetna and Inova Health System—Budhrani is leading the organization’s effort to direct patients to the most appropriate care setting.

A new feature of that effort is an illustrated decision tree that helps patients decide whether an urgent care center or ED is the right place to be treated for the symptoms they’re experiencing.

Innovation Health takes a two-pronged approach to sharing such educational materials and messages, Budhrani said: It distributes them to providers as well as directly to members/patients.

“Being that we’re a unique model, of an insurance company half-owned by a major health system or provider, Inova, and by a major insurer, Aetna, we have opportunities to reach our members and providers in a way that most people can’t,” he said.

That means leaders like Budhrani can sit at a table and communicate directly with the medical directors of a major health system like Inova about how to instruct members about the services Innovation Health offers. Innovation Health also reaches out through its contractual relationship with other providers to let them know that it has one of the largest networks of urgent care centers in the region.

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As for its direct-to-member approach, Innovation Health connects with them through channels like mail, postings on social media, local broadcasts and more, Budhrani said. Materials like the new decision tree are also a complement to tools that Aetna has already deployed like the app iTriage, which navigates members to the closest ED or urgent care center after they type in the symptoms they are experiencing.

While the decision tree is relatively new, Innovation Health already has some positive feedback from distributing it to its non-physician leadership team and their families, Budhrani noted. “They found this greatly helpful because it just created in a picture format, a step 1, step 2, step 3 approach to thinking about their symptoms,” he said.

The overarching goal, according to Budhrani, is to drive home the message to members that they can save themselves a lot of time, money and resources if they go to the right place to receive care.

“Frankly, working in the emergency room, there is still a lot of confusion where to go, and the more we can education our members before they actually get sick and before they actually need the urgent care, the better off everyone is,” he said.