Employee education can reduce unnecessary ER visits

To limit spending on ER bills, employers must make an effort to enlighten employees about alternatives for non-urgent care.

You might think it’s your carrier’s job to educate your employees, but the fact is, often that education isn’t as thorough as it could be. (Photo: Shutterstock)

We’ve all experienced scenarios like this: Your persistent ear pain isn’t severe, but you’re concerned it won’t go away and could be a worsening infection. Finally, late on a Thursday, you decide to take action. What’s the most likely place you’d turn to for care?

If you chose the emergency room, you’re not alone. According to the Healthcare Financial Management Association (HFMA), non-urgent visits to ERs are rising, even though emergency department visits overall are dropping.

And that’s a problem, especially for employers who foot the bill for benefits. The average ER visit costs $1,265.

Related: How is consumers’ use of alternative health care facilities changing?

It’s no wonder that reducing inappropriate emergency department visits is a top goal for employers and plan administrators.

Ongoing, multi-channel education is key

You might think it’s your carrier’s job to educate your employees, but the fact is, that education often isn’t as thorough as it could be. Carriers will typically provide information on available benefit options (such as telehealth or a nurse advice line) at the start of the plan year, but communicating something once is not enough. Some have outreach programs targeting “ER frequent fliers” who go to the ER often for non-emergent reasons—but those are reactive and don’t reach enough people.

Consequently, employers are realizing that they must provide ongoing, multi-channel education to employees about better site-of-care options for non-emergency issues.

With higher and higher ER bills hitting plans, employers are learning that it’s more important than ever for them to make sure that continual reminders are sent to employees about which conditions can be handled by convenient, lower cost sites of care such as nurse advice lines, telehealth, on-site clinics, retail clinics or urgent care. They’re also sharing details on how to find these resources and how much lower out-of-pocket costs will be to members who use them versus the ER.

Keeping this information top of mind when it’s needed is the key to effective communications in this area.

Some examples of good times of year to communicate site-of-care options are:

Some ways to get the message out are:

Common misconceptions can inform communications

The reasons people head to the ER for non-urgent conditions are many. But knowing some of these is critical to helping you better educate employees on alternatives. Here are some common reasons:

My primary care doctor/pediatrician’s office wasn’t open. Heading to the ER is what comes to mind first for many people when their doctor’s office is closed.

I don’t have a doctor I see regularly. Many people—especially those in younger generations—may not value the individual provider relationship as much as they value convenient access to care at the time they feel they need it most. They are primed for just-in-time information about the site-of-care options you provide.

I couldn’t get an appointment quickly enough to see my doctor. Capacity constraints, driven by an increasing shortage of primary care doctors, make it tough for people to get an appointment, especially last-minute. Make sure you share with them covered sites of care before they have trouble getting into their doctor and head right to the ER.

I didn’t think my insurance plan covered telehealth/retail clinics, etc. Many consumers have heard about and seen telehealth and retail clinic options, but they don’t realize their insurance plan covers them or how low their out-of-pocket costs can be. It’s important to be sure they know what’s covered, as well as the co-pay. Telehealth options often cover counseling, psychiatric care and dermatology, just for starters.

I didn’t know I could get help from a nurse or doctor after normal business hours unless I went to the ER. Many people don’t realize that there are nurses and doctors available to diagnose and treat them 24/7. Sharing information on how to reach these resources—affordably—will help bridge this knowledge gap.

Without knowledge of site-of-care options and what’s considered to be non-urgent, it makes sense that so many people with non-critical conditions land in the emergency room, especially when they know the ER can’t turn them away. Employers need to take charge of communicating these details to rein in their rising health plan costs.

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Yvonne Daugherty is vice president, development at Advanced Plan for Health.

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