Patient Engagement

How to Help Underserved Patients Stop Over-Utilizing the ED

The legacy of fee-for-service presents an unprecedented opportunity for FQHC leaders.

A recent report found that just six common, chronic conditions made up 60% of the 24 million emergency department (ED) visits in 2017. About a third of those visits were likely preventable if they’d been treated in a lower-cost outpatient setting. ED use is costly and essentially the opposite of the coordinated care championed by value-based care initiatives, so helping your underserved patients make better use of the ER is a glowing chance for FQHC leaders to make progress in reducing ED use. These steps will help you get started.

Step 1: Understand Their 'Why'

Your patients aren’t turning to the ER on a whim.

Helping them make efficient and effective care decisions starts with understanding where they’re coming from. This is especially true for underserved populations who may have specific challenges around health literacy and understanding their options.

Consider some of these reasons when trying to best understand your FQHC patients’ decisions to visit the ED. They possibly...

  • Weren’t able to access timely, primary care.
  • Weren’t able to find of access during business hours.
  • Have self-perceived urgency and have increased confidence in emergency and urgent healthcare providers.
  • Are following the guidance of family, friends, and even other healthcare professionals that the ED is the best option for their medical situation.
  • Haven’t been exposed to the benefits and proper use of preventive strategies.
  • Are members of specific demographics who might be less likely to use alternative points of access because of a lack of trust, understanding, or availability (i.e. non-English speakers, residents of the South, African Americans, fall into an “other” insurance category such as uninsured or underinsured.)

Keep in mind that any patient can fall under more than one of these and that their “why” can change over time, so the opportunity to better understand them is probably significant and complex.

Step 2. Look to Success Stories for Inspiration

FQHCs are in a unique position to be change-makers in their care communities. This means there’s no shortage of motivating cases that you can use as inspiration in developing programs that help your patients make better use of emergent resources.

For example, the Milwaukee Health Care Partnership was able to drive down unnecessary ED visits by 44% by proactively connecting patients with PCPs when they visited the ED.  Considering that 13% to 27% of ED visits should be routed to a PCP clinic, urgent care, or retail clinic, any FQHC could take inspiration from their results.

Or look at the case of California FQHC, ChapCare, and how they helped their diabetic patients improve medication management and reduce HbA1c levels relative to less-engaged patients. Since patients with higher glycohemoglobin levels tend to visit the ED more frequently, helping them maintain healthier numbers can have a direct impact on ER over-utilization.

Step 3. Take Action

Keep in mind that FQHC access isn’t enough on its own and may not change the behavior of uninsured and Medicaid patients. Making real change in your patients’ decision-making processes will require additional measures from you and your team.

Since over-use of the ED is such an intricate problem, it can be tackled from multiple angles, including:

  • Extending hours of non-emergent services
  • Providing open-access scheduling in ways that align with your care community’s preferences and habits.
  • Considering stakeholder partnerships that leverage work already being done in your community (NY’s DSRIP holds some great examples).
  • Investigating new methods of outreach. (We’ve seen particular success with focusing on high-volume outreach programs that encourage screening and preventive appointments.)   
  • Connect vulnerable patients to needed services. For example, diabetes patients can see positive results from self-management and self-monitoring programs.
  • Provide alternative care, such as urgent care and telemedicine options.

Step 4. It All Starts with Communication

Most importantly, remember that reducing ED over-utilization is an ongoing conversation. Make sure you’re employing best practices when working with underserved and hard-to-reach patient demographics, and if you need any additional support, we’ve developed a comprehensive message library, including our health education programs, custom designed for the specific communication needs of FQHCs who are on a mission to bring holistic and preventive care to the people they serve.

With value-based care initiatives coming into full swing, the ED will only become a more important point of opportunity for healthcare organizations dedicated to serving the underserved. This will be especially true for health center and FQHC leaders who are tasked with addressing complex social determinants of health and educating patients in best using their care programs.

Want to take the first step in that process? Send over your information below and we’ll get you started.

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