Highlighting Key Uses Cases Using Regional Avoidable ED (ET3 Applicable) Rates
The following use cases give examples of how users can find value from this analysis.
Use Case 1: I am a Director for Managed Care and am responsible for assessing and determining potential new payment models for my organization.
While the 2021 performance year for the ET3 program has just started, for those organizations either already participating or looking to participate in an upcoming cycle, this data can identify which counties are good candidates for the ET3 intervention.
Let’s take an example in the Northern Virginia area. If a health system has coverage across multiple counties in Northern Virginia, we can use this dashboard to determine which counties may be the best candidate for an ambulance program (whether that be ET3 or a similar program). As seen in the screenshot below, in Rappahannock County, 19.6% of ambulance-sourced ED visits were either non-emergent or primary care treatable, much higher than the 14.5% benchmark. However, due to the population size of this county relative to others, this comes out to a total preventable spend of $47k. Fairfax County on the other hand, is below the state average coming in at 14.0%, but with the higher population, amounts to $1.17 million in potentially avoidable ambulance-sourced ED spend. Both the prevalence of ambulance-sourced avoidable ED visits and the total volume of ED visits are important to making the decisions of which coverage areas to implement a program like ET3.
Use Case 2: I am a care improvement analyst and want to find areas of high care variation and savings opportunities for my organization.
For health systems not involved in the ET3 program, this data can still be valuable in assessing care gaps. Let’s look at a health system in Southeast Minnesota. We can see that Dodge County has one of the highest rates of ambulance-sourced ED visits that are non-emergent or primary care treatable at 25.2%, relative to the state average of 16.7%.
We can also correlate this high rate to other nationally recognized social indexes. For example, the Social Vulnerability Index published by the CDC looks at factors that impact a region’s ability to react to a disaster taking into account factors like lack of access to transportation and poverty. If we look at the Social Vulnerability Index for Dodge County, we see the county scores a .8909, indicating a high level of vulnerability. Could a lack of access to transportation correlate with higher avoidable ED rates indicating an access issue to primary care? Short answer is yes looking at the plot below – CareJourney has conducted this correlation for this, and other social determinants of health (SDOH) measures in a recent blog so make sure to check that out here.
We can see a positive correlation between transportation access and avoidable ED rates. Check out this and other correlations on our SDOH blog here.
This county breakdown of avoidable ED prevalence allows for prioritization in terms of care initiatives to help lower this rate, leading to follow up questions like:
- Do we have the resources and local support to implement an ET3-like program across populations and payers to help with treatment of lower acuity patients in place or at lower cost settings?
- Do we have an adequate number of PCPs in Dodge County?
- How are the PCPs in Dodge County performing relative to their peers in the region?
- What are the most common ED diagnoses that fall into the non-emergent and primary care treatable bucket? Can we implement patient awareness campaigns to help drive care to lower acute settings?
Use Case 3: I am a health information fiduciary responsible for ensuring a Medicare beneficiary gets the best possible care. For patients like the Medicare beneficiary I care for in our neighborhood, what is the likelihood of avoidable ED visits that can be cared for by my local ambulance company if they participated in ET3?
For providers caring for a patient in their office, it’s useful to understand how the region (in this case county) compares with other neighboring regions and state averages. If a provider’s county has a higher prevalence of ambulance-sourced avoidable ED visits, it is important to know this context when meeting with a patient. Using apps with this information at the point of care to get a “year in review” for a patient can help the provider review past ED utilization for a patient. Does the patient have a history of avoidable ED visits? Does the patient have conditions or impacted by social factors that could lead to avoidable ED visits in the future? From these questions, providers are able to use a patient’s history and supplement it with regional benchmarks to ensure their patients receive the care and education necessary to prevent avoidable ED visits in the future.