Strategies to Manage Unnecessary ER Claims and Costs

Today, unnecessary use of emergency departments (EDs) can significantly impact healthcare spending for employer groups. In 2016, there were 145.6 million ED visits in the United States – a 20% increase in just 10 years. From our data and experience, employer groups vary tremendously in their ED usage, and unnecessary ED visits might account for 25 to 35% of their total healthcare spend. Many of these cases could have been addressed at a lower level of care, such as with a primary care physician, urgent care center, or telemedicine option. Even with available alternatives, unnecessary ED visits have been on the rise.

In this article featured the June 2020 issue of California Broker magazine, we talk about the driving factors causing brokers and their employer groups to work together with health plans, plan administrators, provider networks and employees to reduce this trend.

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