We’ve blogged before about emergency room cost and utilization. ER cost and utilization – or rather the reduction of ER cost and utilization – is a frequent topic of discussion and data analysis for healthcare payer organizations. A recent Milliman study found an annual increase in the allowed per member per month costs for ER of slightly over 10% between 2007 and 2011, which is substantially above the inflation rate during that same period of time. It was also found that during that period of time, the actual number of ER cases per 1000 members decreased very slightly while the unit costs for the individual services provided during the ER cases on increased 1% annually.
Healthcare organizations turn to the data to identify potentially avoidable emergency room events, especially those that could have been provided in a less expensive care setting. In a patient centered medical home (PCMH) reporting project performed by Milliman, ER utilization was one of several utilization targets. The analysis performed identified opportunities for cost reduction, such as identification of members who visit the ER frequently. This analysis also provided insight into access and care management issues by tracking the day of the week ER visits were occurring.
Data analytics is becoming more and more valuable throughout all functions within healthcare payer organizations. Another Milliman study looks at how care coordinators use data analytics for analysis of preventable ER visits by line of business.
Further detail on each of the mentioned studies may be found at:
- What is driving Emergency Room costs?
- Claims-Based Analytics to Identify Potentially Avoidable ER Visits
- Potentially Avoidable Events – The Link to Care Coordination