Looking for medical care can be daunting, and it’s no secret that the emergency room (ER) stands out as a quick and easy option.
From the patient’s perspective, ER visits may appear to be affordable and speedy, but the reality is not so straightforward. In today’s era of high deductibles, it can be unexpectedly costly for patients, and it’s a major driver of unnecessary plan costs, totaling up to $18 billion annually.
Your members have the power to make informed decisions regarding their healthcare options.
Promoting proactive education, offering writing and telephonic communication about when to call the doctor before rushing to the ER, and, more recently, telemedicine solutions have emerged as effective alternatives, providing convenient access to care while reducing costs.
To optimize healthcare utilization, it’s crucial to fine-tune strategies for specific demographics while still prioritizing the best health outcomes for all. By utilizing this approach, we can empower patients with knowledge while celebrating the actions they take to care for themselves and their loved ones.
Together, through honest and informative communication, we can help our audience feel savvier and more confident about their healthcare choices.
As we strive to inform and empower a diverse range of individuals, it’s essential that educational tactics are tailored appropriately. Below are age-based strategy and messaging recommendations:
Unlocking Better Healthcare for Baby Boomers
Every day, 10,000 Baby Boomers, those born between 1946 and 1964, reach retirement age. This exciting milestone is filled with new possibilities, but it also brings unique challenges.
Did you know that employees are staying in the workforce longer? According to the Pew Research Center, a remarkable 19 percent of the labor force is 65 years old or older, compared to 11 percent in 1987.
Why is this important?
Well, as we age, the risk of developing chronic or complex illnesses increases. This makes it even more crucial for health plans to help members prioritize health and wellbeing.
A hospital survey conducted by the U.S. Center for Disease Control and Prevention (CDC) unveiled a startling truth. Between 2007 and 2017, the 60-plus population made an annual average of 29 million trips to an ER. As seniors age, they will continue to represent an increasingly larger share of all ER visits.
These numbers highlight the need to help plan participants explore alternative solutions and to help them make informed decisions about healthcare.
Baby Boomers may be genuinely concerned about the potential health consequences that can arise from displaying symptoms, experiencing a fall, or appearing to be relapsing. These are drivers in this demographic’s increased ER usage.
However, it’s important to acknowledge that this generation did not grow up with alternatives like urgent care or virtual visits. Instead, they were taught from childhood that sudden medical emergencies at off-hours required a visit to the ER.
All too often, seniors and Baby Boomers end up in the ER for non-emergency health situations. But with the right planning and preventative measures in place, many of these scenarios can be avoided.
Here are some solutions to help reduce unnecessary ER visits in seniors and Baby Boomers.
Six Strategies to Avoid Unnecessary ER Visits for Seniors and Baby Boomers
- Have a plan. For those dealing with a chronic or critical illness, having a clear plan for how to handle health issues is essential. Work with your care navigator or case manager to establish a simple plan, like “If you experience Symptom X, call your primary care doctor. If you experience Symptom Y, go to the ER.” With this plan in place and reinforced by the care team, members can proactively manage their symptoms and avoid health setbacks.
- Consider palliative care services. Palliative care provides a more intensive level of support and oversight for people with chronic, life-limiting illnesses like Alzheimer’s, Parkinson’s, ALS, congestive heart failure, and many cancers. By seeking closer supervision and communication with a palliative care team, medical problems can be prevented or addressed before they become more serious, avoiding an unnecessary ER visit for uncontrolled pain.
- Manage medications and care delivery. This age group is more likely to be taking multiple medications, which may cause complications. Ensuring proper instructions and identifying alternative settings to access treatments, like specialty prescription drugs, can prevent medical emergencies and ER visits. The member’s care team can also help identify barriers to getting prescriptions filled and can encourage members to fill prescriptions at the same pharmacy for ease of management.
- Get to know urgent care. Urgent care centers can provide prompt care for non-emergency situations. Encourage senior members to know the location of a nearby center and how to get there in advance so they don’t default to the ER. Proactively getting the details and having them on hand can make seeking healthcare quicker and easier when needed.
- Explore telemedicine options. For those who are comfortable with technology, telemedicine can provide access to medical professionals over video. This can be especially useful for triaging minor issues and obtaining common prescriptions. Even if a member doesn’t have a smart phone, many services offer landline options for consultations.
- Ensure members have a primary care physician. Primary care physicians (PCPs) can provide comprehensive care that is less costly and more effective than the ER. They can administer wellness visits and routine check-ups, coordinate care, and refer patients to in-network specialists. To take advantage of these benefits, provide information for members on local, in-network PCPs and make sure they are aware of any discounted co-pays offered by the health plan.
Empowering Gen X and Older Millennials in Managing Healthcare
Gen Xers and older millennials, aged 30 to 50, have witnessed significant changes in the healthcare system throughout their lives.
This group is known for their adaptability and willingness to embrace new approaches. Balancing their roles as working adults, they often find it challenging to prioritize their health amidst busy work schedules. Moreover, they are highly reliant on their smartphones, particularly women within this demographic.
As parents, Gen X and older millennials bear the responsibility of navigating their children’s healthcare needs. Picture this: it’s midnight, and little Emma is sick with a cough and fever. The dilemma arises—should they rush to the ER or wait until morning? Should they call the doctor or turn to Google for answers?
To support this group in optimizing their healthcare decisions, consider the following tactics:
Four Strategies to Benefit Gen X and Older Millennials in Managing Healthcare
- Introduce innovative digital visits. Allow doctors to assess patients remotely on a live video call. This personal connection with healthcare professionals, available around the clock, is both convenient and reassuring for parents. By being able to view Emma’s symptoms, the doctor can give informed recommendations that consider her behavior and demeanor.
- Telemedicine services. These virtual visits are another important resource for immediate, professional advice and triage.
- Provide digital resources that are accessible and mobile-friendly. These resources should include a search tool that enables members to locate local urgent care centers and primary care physicians who are in-network. Other effective online resources include access to video consultations and links to educational materials. By keeping online tools user-friendly and visually appealing, engagement can be maximized.
Employers and benefits administrators should educate members on these resources during the onboarding process and continuously promote their use.
- Don’t forget print. In addition to digital resources, tried-and-tested print materials are also effective, particularly for this demographic. Provide urgent care center information that can be stuck on the refrigerator, a triage chart for the bulletin board, and screening and immunization reminders via traditional mail methods.
Help Younger Millennials in Making Informed Healthcare Choices
Younger millennials, typically aged 23 to 30, are entering the world of insurance for the first time.
With a thirst for instant solutions and limited familiarity with the healthcare system, it’s common for these healthy individuals to view the ER as a quick fix for primary care needs. They may be inclined to delay seeking medical attention, ultimately leading to unnecessary visits.
Here’s how we can support and educate younger millennials on making proactive healthcare decisions:
Four strategies to encourage wiser healthcare choices in young millennials
- Establish a Primary Care Physician. Encourage them to set up a relationship with a primary care provider promptly. Emphasize the importance of preventive care and highlight low or no-cost options available for screenings and vaccinations. Having a PCP ensures they have a reliable source for medical advice when health concerns arise.
- Educate on Urgent Care Centers. Ensure they are aware of the nearest urgent care facility and the services it offers. Urgent care centers can provide quicker, cost-effective care for less severe medical issues than the ER.
- Highlight the Benefits of Telemedicine. Emphasize the convenience of 24/7 access to telemedicine services and digital visits. These platforms offer quick and easy access to medical advice, improving healthcare accessibility for younger millennials.
- Address ER Misconceptions. Clearly communicate the drawbacks of using the ER in non-emergency situations, such as long wait times, potential exposure to contagious illnesses, and high out-of-pocket costs. Millennials often express dissatisfaction with ER visits. They want efficient and satisfactory care elsewhere. It’s crucial to educate this group on alternative care options to prevent unnecessary emergency visits.
Maximizing Healthcare Efficiency with Proactive Measures
In reviewing these scenarios, a common thread emerges: the importance of proactive action.
During urgent health situations, individuals often struggle to make clear decisions and remember their available options. It’s crucial for them to have a ready plan in mind, easily accessible, or on their smartphones.
At Personify Health, our commitment to proactivity drives a remarkable 4.3-to-1 return on investment through our ER Solutions program.
By delving into our claims data, we pinpoint patients who have sought care in the ER when a different healthcare setting would have sufficed. Upon identification, Personify Health proactively engages with these members to educate them on more cost-effective alternatives.
Moreover, we proactively identify individuals at risk of impending health issues that may lead to an ER visit, ensuring they are well-informed and prepared for any immediate healthcare needs. The journey to proper ER utilization begins early with new members and continues through regular, ongoing support.
The integral role of care managers in overseeing individuals with chronic illnesses cannot be overstated in effective ER utilization management. From providing early education on treatment options and guaranteeing patients have a primary care physician and a personalized care plan to averting crisis through symptom management and seamless care coordination, care managers act as all-encompassing quarterbacks in the healthcare journey.
Technology tailored for consumer ease significantly enhances member engagement.
Accessible online platforms not only educate members but also encourage continued interaction. Our user-friendly integrated portal serves as a hub for members, facilitating provider searches, guiding them to alternative care centers, aiding in selecting primary care physicians, and enabling the utilization of services like telemedicine.
Embracing proactive approaches and leveraging supportive technologies form the cornerstones of our mission to streamline healthcare experiences and empower individuals to make informed decisions confidently. We built our platform to take on some of our industry’s biggest challenges—and our
customers’ biggest frustrations. We put everything in one place, so members and HR teams have one less thing to manage.
Empowering Positive Change through Proactive Healthcare Solutions
Through our efforts to guide members towards alternative healthcare options, Personify Health has not only achieved substantial cost savings but also succeeded in driving behavioral changes among our valued clients:
- A notable 17% reduction in emergency room costs
In essence, the ER Solutions program aims to accomplish three pivotal objectives:
- Preplanning and Education: Focusing on individuals most likely to require ER services, we prioritize proactive education and readiness.
- Identifying Appropriate Care Settings: We diligently pinpoint alternative care settings suitable for each member’s specific needs.
- Introduction to Telemedicine Resources: By offering comprehensive education on telemedicine resources, we ensure easy access to crucial healthcare information 24/7.
Tailoring strategies based on the unique needs and behaviors of distinct demographic groups will yield the most significant impact on member behavior.
Our ultimate aim is to guarantee that each member consistently receives the safest and most appropriate healthcare option available, fostering a future where informed decision-making is paramount.