This report provides data that supports analysis, tracking and trending of avoidable ER trends by all facilities, members, PCPs, and diagnoses over a selected period of time with cost and utilization provided.   The color-codeds offer the user a quick reference for positive (green) or negative (red) trends.  

 

 

Target Audience for this Report 

Chief Medical Officer, Compliance & Regulatory Department, Finance Department and CFO, Leadership Team, Medical management/Care Management Department, Pharmacy & Therapeutics Committee, Physician Relations, Quality Management, and Utilization Management.

 

Business Processes Impacted by this Report

Avoidable ER Rate informs the health plan of a key opportunity to reduce costs and improve care continuity by reducing this number.  Evaluating patient access to PCPs and Urgent care appointments is important in impacting this rate.

 

Network development of urgent care, telemedicine, and PCPs with access to care when members are ill, are all strategies that can be driven and monitored by this report.

 

Care management will link this report to members, PCPs, and diagnoses to create focused member support resulting in reduced ER utilization.

 

Education of members, families and employers about when and where to access care can improve this rate.  This can be provided on the health insurance card and reinforced by both the health plan and the employers.  Post ER communication by care managers can be effective in coordinating follow up appointments and preventing follow up ER visits.

 

 

Detail and Definitions

 

Trending Graphs

 

Period by Period Trend – ER Avoidable Rate

  • ER Avoidable Rate Percentage
  • Trend Period

Period by Period Trend – ER Visits / 1000

  • ER Visit Rates per 1000
  • Trend Period

Period Over Period Trend – ER Avoidable Rate

  • Percentage of change from prior period.
  • Trend Period

Period Over Period Trend – ER Visits / 1000

  • Percentage of change from prior period.
  • Trend Period

 

 Header

  • ER Visits
  • AER Visits
  • AER Rate
  • Potential Savings Opportunity

 

Avoidable ER (AER) by Facilities

  • Facility
  • AER Visits
  • ER Visits
  • % AER Visits
  • AER Cost

 

AER by PCP

  • PCPID
  • PCP Name
  • AER Visits
  • ER Visits
  • % AER
  • AER Costs

 

AER by Member

  • Member Number
  • Member Name
  • AER Visits
  • ER Visits
  • % AER
  • AER Costs

 

Member AER Visit Detail

  • Service Date
  • Claim #
  • Member Number
  • POS
  • Dx Description
  • % AER (Red=Avoidable, Green=Non-Avoidable)