Prescription for ER overuse: Engage patients in EHR data and health information exchange
Louisiana is known as being woefully behind when it comes to healthcare. But in the realm of population health, it is making some serious progress. The state, in fact, launched both a direct-to-consumer patient engagement campaign and a health information exchange-enabled emergency department data registry.
Consequently, in one year the state has realized a 23 percent increase in health IT utilization among at-risk patients and a 10.2 percent decrease in non-emergent utilization of emergency departments among members of one of the state’s Medicaid MCOs.
“This all came about from a partnership with the state department of health because Louisiana for far too long has been on the wrong end of healthcare ratings,” said Jamie Martin, marketing and communications manager at the Louisiana Health Care Quality Forum. “So on the one hand, engaging consumers in the use of health IT to manage their care was critical to improving our standing in healthcare ratings.”
The partnership developed and implemented marketing and communication plans statewide, with core messaging on the benefits of health IT, electronic health records, patient portals, and the importance of having a paper copy of or electronic access to one’s medical records.
“Between August 2015 and May 2016, consumer awareness of EHRs went up 23 percent and opt-in to Louisiana’s Health Information Exchange went up 3 percent, and patient portal use rose 31 percent,” Martin said. “Additionally, the number of patients with current copies of their health information went up 9 percent, and the number of patients requesting copies of or electronic access to records went up 12 percent.”
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On the other hand, Louisiana started a pilot program with one of its Medicaid MCOs, studying how the state could use data in a more timely manner to provide the MCO as well as physician clinics in the pilot with information that would help reduce avoidable emergency room visits.
“We wanted to be much more aggressive with chronic disease management for patients who are going to the emergency room for chronic conditions and not utilizing primary care,” said Cindy Munn, CEO of the Louisiana Health Care Quality Forum. “We built a registry and analytics platform on top of the exchange; hospitals not participating in the HIE could submit their emergency department ADT data.”
Every 24 hours, the system attributes patients to the appropriate health plans and the appropriate primary care physicians, then the health plans work with the physicians to prioritize the patients who need to be seen as soon as possible.
“The system and the health plans provide support to the physicians, so that if, for example, a patient has not had all of her immunizations, the physician has that information readily available,” Munn explained. “This was all done in a shared savings model, and we saw a significant decrease in the utilization of emergency rooms for avoidable visits, as well as improvements in quality outcomes. Patients are being seen by physicians instead of emergency rooms, even with an increase in the number of Medicaid patients.”
Louisiana is now expanding this model to all five of the state’s Medicaid MCO plans and is offering it to commercial health plans and self-funded employers.
“It’s really a very simple approach: You are getting critical information to the players who can make the difference – the health plans and primary care providers – in a more timely manner so it can be acted upon,” Munn said.
The Louisiana Health Care Quality Forum said the efforts so far are advancing the broader goals of population health.
“This is a step in the right direction,” Munn said. “You have to have the technology – that is where analytics and other systems come in. You have to have the primary care providers and hospital providers participating. And you have to have patient engagement – where the patient understands what the appropriate care settings are and how to become more involved in their healthcare, that kind of engagement.”