By Duranya Freeman
Hospital emergency rooms are often thought of as medical battlefields, full of car accident victims, broken bones and raging fevers.
Yet the reality is that not all ER visitors are at death’s door, writes NCSL’s Lisa Waugh in the June issue of State Legislatures magazine.
For some patients with chronic issues like diabetes, asthma and congestive heart failure, ER visits are their version of health care. Although they only make up 5 percent of total patients, these “super-utilizers,” as they’re known, account for 55 percent of total health care costs.
Thirty percent of them also have behavioral disorders, including anxiety and substance abuse, which can further complicate treatment.
Care coordination programs are one solution. To find program candidates, analysts look at billing records, ER utilization and state Medicaid records. Then, they help chronic patients get back on the right track by creating better doctor-patient relationships and giving them access to community groups to improve stability at home.
Lawmakers in Maryland, New Jersey, Oregon and Texas have passed legislation allowing coordinated care programs to begin collecting patient data.
These programs can benefit not only patients and doctors, but also lawmakers who can track health care spending in their state. Fewer emergency room patients mean lower Medicaid costs for everyone. The cost-effectiveness of programs like these could be a first step in making health care more affordable for states and individuals alike.
Duranya Freeman is NCSL’s communications intern.