Mass. employers team up to tackle health care costs
A group of 20 organizations are teaming up to try to reduce unnecessary emergency room visits.
Major business groups in Massachusetts have developed a novel strategy for lowering health care costs.
A group of 20 organizations representing employers such as the state restaurant association and the Boston Chamber of Commerce, are teaming up to try to reduce unnecessary emergency room visits. Their goal is to save $100 million in ER cost by 2020 by getting people to address non-emergency medical issues, such as colds and sinus infections, through primary care.
The group, citing research from the state Health Policy Commission, suggests that 42 percent of visits by state residents to the ER are avoidable. That amounts to 1 million visits a year.
To achieve the desired reduction in spending, ER visits would likely have to drop by about 20 percent.
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However, determining whether an ER visit is justified is hardly an exact science. A heart attack is certainly a justified visit, but sometimes what seems like a heart attack turns out to be heartburn. Indeed, the American College of Emergency Physicians estimates that only 3.3 percent of ER visits are avoidable.
Many people with insurance often go to the ER simply because the care is prompter or because there is not a nearby primary care physician or specialist who is in their insurance network. In a 2015 study, the American College of Emergency Physicians reported an increase in the number of insured patients relying on the ER for non-emergency care, a phenomenon the organization blamed on “narrow networks” in many of the Affordable Care Act plans.
In their attempt to reduce ER visits, the coalition of employers are partnering with the state hospital association and the state association of emergency physicians, along with two major insurers and the Health Policy Commission, a state agency.
So far, the strategies for reducing ER visits remain vague. There is talk of educating employers and their workers about the issue and incentivizing patients to use the most “appropriate” care.
“We can achieve these ambitious targets without having to make this a punitive effort in any way,” Health Policy Commission Executive Director David Seltz tells WBUR. “This is really going to be about providing better care to patients.”