Anthem Blue Cross and Blue Shield in Indiana is piloting an ER initiative program aimed at reducing emergency room visits.
The program is an effort to help ensure that Hoosier Healthwise, a healthcare program for low-income families, pregnant women and children that is sponsored by the state of Indiana through the Family and Social Services Administration, provides members with a medical home with their primary care physician for preventive care.
According to the Partnership for Medicaid, almost 20 percent of all emergency room visits are made by Medicaid beneficiaries. In 2003, Medicaid spent an estimated $8 billion for 22 million hospital emergency room visits.
Anthem's ER Initiative Program is being piloted in Evansville, where it serves nearly 10,000 Medicaid managed care members. In the six months since introducing the program, Anthem has seen an approximate 6 percent to 9 percent decrease in the number of visits to the emergency room by its HHW members.
The same program was implemented five years ago by Anthem's affiliate in California; that program still sees decreases in unnecessary visits to the emergency room by its Medicaid members.
Deaconess Hospital, a 365-bed acute care teaching hospital serving southern Indiana, southeastern Illinois and western Kentucky, collaborated with Anthem to track and trend emergency room visits. Anthem's Community Resource Center staff discovered an unusually high rate of visits by Anthem members at each of the hospitals.
"Our ability to capture this information in real time as the member was in the emergency room is an important part of our program," said Stanley Reed, medical director for Anthem Blue Cross and Blue Shield in Indiana. "Through a series of questions we're able to determine if the member has seen their primary care physician, if not, why they haven't, and, more importantly, what medical need brought them to the emergency room."
Anthem officials found that many conditions that brought members to the emergency room could have been treated by their physicians, or preventive measures could have avoided the visit. In addition, Anthem conducted member outreach and education in the days following an emergency room visit to ensure members knew how to access their primary care physician for follow-up and future medical care.
"This program is a testament to the personalized care Anthem's Community Resource Centers offer Hoosier Healthwise members," said Rob Hillman, president and general manager for Anthem Blue Cross and Blue Shield in Indiana. "In addition, this program demonstrates an innovative approach that helps to eliminate unnecessary costs in our healthcare system by providing the right level of care at the right time for our members."