Emergency department overcrowding and rising costs are an ongoing issue in the healthcare industry, but the CEO of one major insurance company says a few key steps can reduce unneeded emergency care.
Previous research indicates than 70% of visits to the ER for those enrolled in employer-sponsored health plans are unnecessary, which can result in wasteful spending and long waits for patients who may need more immediate treatment.
Bruce Broussard, CEO of Humana, writes in a LinkedIn post that primary care providers must be empowered to actively respond to this problem.
For example, he writes, a PCP who may work with a number of people diagnosed with congestive heart failure. That doctor should be able to work alongside the patients' health plans to educate them on personal wellness, like healthier eating habits, which could prevent an unneeded trip to the ER.
“In a population-health world, the PCP is the quarterback, coordinating patient care among the specialists,” he writes. “Patients always need access to their PCP in a timely manner.”
Those PCPs should also be able to ensure that people have timely access to specialists, according to Broussard. Health plans and specialists need to work alongside primary care providers to ensure that access, he writes.
Payers can also take the lead on educating enrollees on issues like medication adherence and the differences between emergency care and urgent care, he writes.
Urgent care centers often have shorter wait times and lower costs than the ER, but people may be unaware of the differences between the two. In addition, people who fail to take medications as prescribed are also more likely to make an unneeded visit to the hospital and increase the cost burden on the healthcare system.