BCBSRI finds that 40% of its covered emergency visits unnecessary

PROVIDENCE — An internal task force at Blue Cross & Blue Shield of Rhode Island has identified 40 percent of emergency department visits it covers, about $90 million in care in 2018, is unnecessary, and eliminated $4.5 million of that waste, BCBSRI announced Thursday.

Since its creation this year, BCBSRI’s Emergency Department Task Force’s efforts have resulted in a reduction in emergency department visits and significant savings among both Medicare and commercial populations, the company said. The 14-member team including primary care doctors and nurses, case managers, pharmacy professionals, social workers and project managers, identified factors contributing to rising emergency department visits – including use of the emergency department in place of a primary care provider – and developed advice for patients intended to minimize unnecessary emergency department visits, according to BCBSRI.

Unnecessary emergency department visits included people with symptoms including back pain, flu symptoms, ear or sinus pain, muscle sprains or bumps, cuts and scrapes. Many of such complaints can be addressed by a primary care provider at retail health clinics, or at urgent care centers.

Task force tactics included verbal and print campaigns launched by primary care provider partner offices and BCBSRI case management support for members, said Charlotte Crist, registered nurse and BCBSRI’s managing director of clinical programs.

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The insurer also advised on the best destination for certain types of care in the online and print versions of the company’s member newsletter, Rhode Ahead, as well as in print handouts and posters at doctor’s offices, Crist said.

“While we certainly recognize that many health situations require emergency department care, we are focused on decreasing avoidable visits to the emergency department, which result in increases in health care spend,” said Dr. Matt Collins, vice president of clinical integration at BCBSRI. “We all have a role to play in lowering health care costs, and by educating our members and working closely with the provider community to enhance care coordination, we can realize meaningful savings in health care costs,” he said.

So far, BCBSRI reports its task force’s efforts have resulted in:

  • A 3.2 percent reduction in emergency department use by commercial members, equaling $3.5 million in cost avoidance
  • A 0.05 percent reduction in emergency department use for Medicare members, equaling nearly $1 million in cost avoidance

Rob Borkowski is a PBN staff writer. Email him at Borkowski@PBN.com.